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United Against Female Genital Cutting 


Understanding 
Female Genital Cutting 
in the Dawoodi Bohra Community: 

An Exploratory Survey 


Author: Mariya Taher 

February 2017 


Acknowledgement and Thanks 

Sahiyo would like to acknowledge and thank all those individuals and organizations who 
generously shared their time, thoughts, and experience with us and helped make this online 
survey possible. 

For their invaluable ideas, guidance and feedback on the design of the survey tool and 
questionnaire, we are indebted to: Shaheeda Tavawalla-Kirtane, co-founder of Sahiyo; 
Molly Melching, Founder and CEO of Tostan; Diane Gillespie, Emerita Professor, University 
of Washington Bothell; Hannah Wettig, Arvid Vormann, John Chua and others from WADI; 
and Gerry Mackie, University of California, San Diego. 

The primary author of this report is Sahiyo co-founder Mariya Taher, MSW, MFA. For their 
contributions in reviewing, editing and proofreading the report, we are thankful to Aarefa 
Johari, co-founder of Sahiyo; Reyhana Patel (Islamic Relief Canada); Chandni Shiyal; and 
Lubaina Plumber (Washington University School of Law, St Louis). We are also thankful to 
Nicole Ifill for her crucial statistical inputs and data analysis of the survey results, and Neha 
Dani for designing the survey report. 

Additionally, we would like to thank Wallace Global Fund and Orchid Project for their 
continued support to help Sahiyo pursue programming to address Female Genital Cutting in 
India. 

Most importantly, the depth and scope of this report is wholly due to the willing participation 
of the individuals who completed the survey, despite their fear and hesitation to come 
forward (even anonymously) with their experiences of Female Genital Cutting. 

For more information on Sahiyo and this study, please contact info@sahivo.com or visit 
www.sahivo.com . 


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Table of Contents 


Abstract 4 

Introduction and Purpose 5 

Literature Review 10 

Methodology 22 

Key Findings 27 

General Information 28 

Q1 : Ages of Participants 28 

Q2: Education Level 29 

Q3: Marital Status 29 

Q4: Current Income Level 30 

Q5: Previous Income Level 30 

Q6: Previous Religion 31 

Q7: Current Religion 31 

Q8: Profession 31 

Q9: Current Country of Residence 32 

Personal Experience - Part 1 33 

Q10: Socializing With Other Dawoodi Bohras 33 

Q1 1 : Awareness of Khatna 33 

Q12: Friends or Family Members Who Underwent Khatna 34 

Q13: Khatna Performed on Mother 34 

Q14: Khatna Performed on Themselves 35 

Personal Experience - Part 2 35 

Q1 5: Age of Khatna 36 

Q1 6: Decision Maker of Khatna 36 

Q17: Country Khatna Occurred In 37 

Q18: Taken Out of Country to Have Khatna Done 37 

Q19: Location of Khatna 38 

Q20: Who Performed Khatna? 39 

Q21 : Type of “Cutting” Performed 39 

Q22: Narrative Question - Experience about their Khatna 40 

Q23: Physical or Health Complications 41 

Q24: Mental State Immediately After Khatna 42 

Q25: Emotional Impact on Adult Life 42 


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Q26: Khatna and Sex Life 44 

Q27: Khatna and Sex Life - Positive or Negative 44 

Q28: Narrative Question - Khatna and Sex Life Details 45 

Social Experience 45 

Q29: Perception of Not Undergoing Khatna 46 

Q30: Explanations Given to Perform Khatna 46 

Q31: Men’s Knowledge on Khatna 47 

Q32: Men’s Expectation on Khatna Occurring 47 

Q33: Men’s Knowledge of Khatna When Female Relatives Undergo It 47 

Q34: Continuing Khatna on Their Daughter 48 

Q35: Khatna Continuation in Community 49 

Q36: Belief around Prevalence of FGC in Community 50 

Q37: Khatna Performed Amongst Other Communities in India 50 

Discussion 51 

Conclusion 61 

References 65 

Glossary 69 

Appendix A: FGC Online Survey 72 

Appendix B: E-mail sent to Participants 82 


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Abstract 


Female Genital Cutting or FGC (also known as female genital mutilation and female 
circumcision) comprises all procedures that involve the partial or total removal of external 
genitalia or other injury to the female genital organs for cultural, religious, traditional and 
other non-medical reasons. FGC is primarily known to be practiced in sub-Saharan African 
countries, but its prevalence is found globally, including within Asian and Asian diaspora 
communities. Currently, little to no representative data has been collected on the practice 
within these communities. 

This study attempts to understand the views, beliefs and rationales of the practice held by 
women belonging to the Dawoodi Bohra community to enable policymakers, donors, 
program developers, health professionals, and other key stakeholders to have a clearer 
insight into ending this human rights violation. 

The Dawoodi Bohras are a sub-sect of Ismaili Shia Islam, whose administrative 
headquarters are located in Mumbai, India. The majority of Dawoodi Bohras reside in India 
and Pakistan, but over the last few decades there has been a rapid and significant migration 
of Dawoodi Bohras to the Middle East, East Africa, Europe, North America, Australia, and 
other parts of Asia. Three hundred and eighty-five women, affiliated with the Dawoodi Bohra 
community, living in the above mentioned disparate geographic locations, participated in 
this study by filling out an online survey. Findings indicated that 80% of the survey 
respondents had undergone FGC, and that various rationales were given for the 
continuation of FGC, including for 1) Religious purposes (56%), 2) To decrease sexual 
arousal (45%), 3) To maintain traditions and customs (42%), and 4) Physical hygiene and 
cleanliness (27%). 

Regardless of the justifications given by the Dawoodi Bohra community, the findings 
demonstrate that FGC is deeply rooted in the community’s culture. Understanding the 
complex social norms and cultural value systems that shape the meaning and significance 
of the practice within this community is critical to the work of anti-FGC advocates. On a 
constructive note, despite the high prevalence of FGC within the survey participant 
population, 82% stated they would not continue FGC on their daughter(s), indicating a 
window for change and abandonment of FGC among future generations of Dawoodi 
Bohras. 


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Introduction 

and 

Purpose 


Introduction and Purpose 

For the first time ever, the United Nations has prioritized the elimination of Female Genital 
Mutilation/Cutting (FGM/C) under the goal of achieving gender equality as part of the 
Sustainable Development Goals (SDG) - a 15-year plan to help guide global development 
and funding in the areas of critical importance for humanity and the planet. 

Since 2015, Sahiyo has been working with the Dawoodi Bohra community to advocate for 
the abandonment of the practice of ‘khatna’ or Female Genital Cutting (FGC). In June 2015, 
Sahiyo introduced an online survey to gather data on FGC and gain insight into the 
prevalence of FGC amongst the Dawoodi Bohra communities in India and around the world. 
The study was done with the intention to establish strategies that can bring the practice to 
an end. Such strategies could include the establishment of a hotline for girls seeking 
assistance; the provision of education and resources to help those on the frontlines, such as 
educators, healthcare workers, and law enforcement; implementation of public awareness 
campaigns; and appropriate funding to support these efforts. 

Prior to this survey, little to no data existed about khatna or Type I FGC within the Dawoodi 
Bohra community. Yet, as more and more women are publicly speaking about FGC within 
this community - as can be attested to by increased media attention on the topic in the year 
2016 - understanding how to engage with the community to tackle this issue becomes of 
paramount importance. This document summarizes findings from the exploratory study. 

About Sahiyo 

Sahiyo (the Bohra Gujarati word for ‘saheliyo’, or friends) began in 2014 as a conversation 
between five women who felt strongly about the ritual of ‘khatna’ or Female Genital Cutting 
(FGC) in the Dawoodi Bohra community. The group includes a social worker, a researcher, 
two filmmakers and a journalist, who had all been speaking out, in their own ways, against 
the practice of khatna. As their collaboration grew, they realized the need for an organized, 
informed forum within the community that could help drive a movement to bring an end to 
khatna. The mission of Sahiyo is to empower Dawoodi Bohra and other Asian communities 
to end Female Genital Cutting and create positive social change through dialogue, 
education and collaboration based on community involvement. 

Report Overview 

The report will focus on the following points mentioned below: 

• Literature review on the topic of female genital cutting 

• Survey project’s methodology 

• Findings of the research 

• Analysis of key findings followed by recommendations. 


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What is FGC? 


Female Genital Cutting (FGC) (also known as female genital mutilation and female 
circumcision) comprises all procedures that involve the partial or total removal of external 
genitalia or other injury to the female genital organs for cultural, religious, traditional and 
other non-medical reasons. According to the World Health Organization (WHO) (2016), the 
procedure has no known health benefits and the removal of or damage to healthy genital 
tissue may cause several immediate and long-term health consequences. Further, FGC 
violates a series of well-established human rights principles, including the principles of 
equality and non-discrimination on the basis of sex, the right to life when the procedure 
results in death, and the right to freedom from torture or cruel, inhuman or degrading 
treatment or punishment, as well as the rights of the child. The abandonment of FGC has 
been listed as a target under Goal 5 of the UN’s Sustainable Development Goals 
(Sustainable Development Goals, 2016). 

A Brief History of Dawoodi Bohras 

The Dawoodi Bohras are a sub-sect of Ismaili Shia Islam, who trace their roots back to the 
Fatimid dynasty of Yemen in the 11th century. The Dawoodi Bohras believe that the 
religious or spiritual leader of the community is the Da’i al-Mutlaq, referred to with the title of 
‘Syedna’. The post originated in Yemen but moved to Gujarat, India, in the 1500s. Today, 
the Dawoodi Bohras are predominantly a Gujarati-speaking business community with their 
own distinct culture and a population estimated to be between one and two million. The 
majority of Dawoodi Bohras reside in India and Pakistan, but over the last few decades 
there has been a significant migration of Dawoodi Bohras to the Middle East, East Africa, 
Europe, North America, Australia, and other parts of Asia. The administrative headquarters 
of the Dawoodi Bohras as well as the office of the current (53rd) Da’i are in Mumbai, India. 

Due to the diverse roots of the Dawoodi Bohras, the community has a mixture of Yemeni, 
Egyptian, Indian, and African elements, and thus differs from other Shia Muslims in certain 
beliefs and practices. For example, the Dawoodi Bohra language, called Lisan al-Dawat, is 
written in Arabic script, but is derived from Urdu, Gujarati and Arabic (Dawoodi Bohra’s, 
2016). The Dawoodi Bohras also stand out because of their distinct attire, their food and 
their reputation as a largely wealthy and well-educated community. In western India, 
Dawoodi Bohras are known for having a more “progressive” attitude towards women - most 
Dawoodi Bohra women are educated, work in various professional fields and are also 
known to run home-based businesses even if they do not work outside. 

The Practice of Khatna or FGC among the Dawoodi Bohras 

Dawoodi Bohras are the most well-known Muslim community in India to practice FGC, 
known as ‘khatna’ or ‘khafd’ in the community - a ritual that many Islamic scholars around 
the world do not endorse. In most instances, the process involves the removal of a pinch of 
skin from the clitoral hood at the age of seven, or between the ages of six and twelve. While 
the Quran, Islam’s holy book, does not sanction FGC, the Daim al-lslam, a religious text 
followed by this community, does endorses the practice. It is likely that the practice came 
down to the Dawoodi Bohras from Yemen, where Dawoodi Bohras trace their roots and 
where FGC is widely practiced in several provinces. As the Dawoodi Bohras have 


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immigrated to other parts of the globe, this tradition has migrated with them and is known to 
be performed in secret behind closed doors in countries where legislation banning FGC 
exists. Although the practice is considered widespread, the topic was, until recently, rarely 
spoken about and/or mentioned in open discussions. The outcome of this research is 
focused on understanding the nature of this practice within the community, thereby 
contributing knowledge to the field of gender violence, public health, and social work. 

Significance of Research 

According to the United Nations, at least 200 million women in 30 countries have been 
subjected to FGC. However, these statistics are largely restricted to sub-Saharan Africa and 
ignore the global scope of the issue. In Indonesia alone, half of girls under the age of 14 
have gone through FGC (UNICEF, 2016). The practice has been cited to occur in South 
America, as in various countries in Asia and the Middle East including, Oman, Yemen, 
United Arab Emirates, Pakistan, Iraq, Iran, Malaysia, Singapore, Thailand, Sri Lanka, 
Maldives, Brunei, Russia (Dagestan) and Bangladesh. Owing to global migration patterns, 
FGC has spread to Europe, North America and Australia as well. The map below depicts a 
few countries where FGC has been cited to occur. 



Th&fPiilippines 




Togo 

5 Cameroon 

1 Central African 
Republic 


Uganda 



For more information and a full list of references see: 

https ://orchid p roject .o rg/factsheet-lgc-in-the-mid d le-east-a nd-asia/ 


Map 1: Provided by Orchid Project 

The National Association of Social Workers (NASW) in the United States points out that the 
key to ending this form of social oppression is to understand the religious, cultural, ethical, 
mental and physical aspects of FGC among populations where it is practiced (Social Work 
Policy Institute, n.d.). According to WHO guidelines released in 2016, there is an urgent 


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need for more research on FGC prevention and intervention programs to learn how to help 
women and girls who have undergone FGC. 

Abdulcadir (2014) concludes in his research paper that additional studies focusing on “the 
diversity of women with FGM: different types of cutting, origins, cultures, experience, 
complications, and migration” are also needed. He further suggests that “future studies 
should be multicenter and prospective, and should involve countries where FGM is 
practiced as well as countries of migration”. 

The purpose of this research project is to understand the perceptions, beliefs and rationales 
of FGC among the global Dawoodi Bohra population. As global migration increases, and as 
the Dawoodi Bohra community continues to migrate to new parts of the world, the number 
of women and girls who have undergone FGC or who will be at risk of it will continue to 
increase in every country. This increase makes it crucial for front line workers, including 
activists, health workers, social workers, legal professionals, etc. to understand the cultural, 
ethical, mental, and physical aspects of FGC as they encounter it in practice. 

Aims and Objectives of the Study 

The aims and objectives of the study are as follows: 

• To obtain credible statistics about the nature of Dawoodi Bohras who have 
undergone FGC and the numbers who continue to practice it. 

• To obtain objective data on the perceived harmful and/or beneficial physical, 
psychological and sexual effects of FGC. 

• To examine the various justifications given within the Dawoodi Bohra community to 
continue the practice of FGC. 

• To determine community-based interventions that can lead to the abandonment of 
FGC based on findings of the study. 


9 


Literature Review 


10 


Literature Review 


Introduction 

To study the prevalence of FGC amongst the Dawoodi Bohras, an extensive review of 
literature focusing on multiple facets of Female Genital Cutting (FGC) was conducted. A 
theme worth noting in the literature is the overarching plethora of academic papers about 
FGC as it occurs in Africa and in Western societies where African immigrants from FGC- 
practicing countries are settled (Shell-Duncan, 2008; Boyle et al., 2001; Prazak & Coffman, 
2006). Meanwhile, the occurrence of FGC in other countries, such as India, is mentioned in 
brief, in just two or three sentences (Monahan, 2007; Jaeger et al., 2008; Burson, 2007). 
Ghadially (1991) also notes that literature on the ‘sunnah’ version of FGC (the form more 
often performed in Asia) was lacking in comparison to the available literature on forms like 
clitoridectomy and infibulation. The literature thus reveals an underlying assumption that the 
number of cases reported in those “other countries” is too low to suggest a real social 
problem. 

This literature review, then, attempts to highlight the nature of FGC from a global 
perspective and is broken into the following categories: 1) terminology related to FGC, 2) 
history of FGC, 3) justifications given for FGC, 4) physical consequences of FGC, and 5) 
interventions used to end FGC. 


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Terminology Related to FGC 

The World Health Organization (WHO) has grouped the types of FGC into four broad 
categories, with subdivisions to indicate the differences in genital cutting that might occur 

within an FGC-practicing 
community. 

The World Health Organization’s 
categories of FGC have been 
consistently used to define the type 
of cutting occurring within practicing 
communities. However, the same 
cannot be said when it comes to the 
terminology chosen to discuss the 
practice. Academics, NGOs, 
activists, and communities carrying 
out the practice have intensely 
debated the correct terms to refer to 
this practice, a debate that is 
informed by an even larger debate, 
that of cultural relativism versus 
universalism (Healy, 2007). 

For example, terms like female 
circumcision are considered more 
culturally accepted within practicing 
communities, and researchers using 
those terms appear to be more 
culturally relativistic. Proponents of 
the term Female Genital Mutilation 
(FGM), however, state that the FGM 
accurately reflects the invasiveness 
of the procedure and the violation of 
human rights that is incurred 
(Jaeger, Caflisch, & Hohlfeld, 2008). 
Those who choose the term FGM 
believe that a more universal term 
must be used that disregards 
cultural contexts. However, critics of 
terms like FGM consider it to be an insulting and pejorative Western construct which is 
insensitive to the traditional value implied in the practice 

This may help to explain why Ghadially (1991), a researcher from Mumbai, India, who 
conducted a small exploratory study using a convenience sample of Bohra Muslims in India, 
used the term “Female Circumcision” or FC. Islamic Relief Canada (2013-2016) also found 
in their research on FGC in Indonesia that certain terms can add to the traumatization of 
survivors: 


WHO FGC 
Categories 

WHO Definitions 

Type 1 

Partial or total removal of the clitoris and/ 
or the prepuce (clitoridectomy). When it is 
important to distinguish between the major 
variations of Type 1 cutting, the following 
subdivisions are proposed: 

Type la - removal of the clitoral hood 
or prepuce only 

Type lb - removal of the clitoris with 
the prepuce 

Type II 

Partial or total removal of the clitoris and the 
labia minora, with or without excision of the 
labia majora (excision). When it is important 
to distinguish between the major variations 
that have been documented, the following 
subdivisions are proposed: 

Type lla - removal of the labia minora 
only 

Type lib - partial or total removal of the 
clitoris and the labia minora 

Type lie - partial or total removal of the 
clitoris, the labia minora and 
the labia majora 

Type III 

Narrowing of the vaginal orifice with creation 
of a covering seal by cutting and appositioning 
the labia minora and/or the labia majora, with 
or without excision of the clitoris (infibulation). 
When it is important to distinguish between 
variations in infibulations, the following 
subdivisions are proposed: 

Type Ilia - removal and appositioning of 
the labia minora 

Type II lb - removal and appositioning of 
the labia majora 

Type IV 

All other harmful procedures to the female 
genitalia for non-medical purposes, for 
example: pricking, piercing, incising, scraping 
and cauterization. 


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Experiences from community-based interventions may indicate that the term 
‘mutilation’ can, in some instances, actually add to the traumatisation of an 
individual. Girls and women who have undergone FGC can feel victimised, 
stigmatised and offended by the word ‘mutilation’ and its derogatory 
connotations (p.8). 

Throughout academic discourse, the term “female circumcision”, “female genital cutting”, 
“female genital surgery”, “ritual genital surgery”, “sexual mutilation”, and female genital 
mutilation” have been used to describe the practice (Rahman and Toubia, 2000). Lastly, 
Christoffersen-Dev (2005) used the term “female genital practices” to capture “the spectrum 
of body-altering practices involving the female genitals”. He refuted the acronyms of FGC 
and FGM, stating that meaning is lost in the acronyms and that they objectify the practice as 
a rare medical syndrome. 

For purposes of this literature review and to ensure no additional harm is caused to 
survivors, the term Female Genital Cutting (FGC) is used as it appears to be a compromise 
between the two warring viewpoints. And as Dustin & Davies (2007) stated, “the term FGC 
is a more neutral, non-blaming term, which still graphically represents the injuries that girls 
suffer.” 

History of FGC 

Today, although the procedure is associated primarily with Muslims, it is also carried out 
amongst various religious groups and Christians (Cameroon, Egypt, Mali, Senegal, Nigeria, 
Niger, Kenya, Sierra Leone and Tanzania); the only Jewish group known to have practiced 
it is the Beta Israel of Ethiopia (El-Damanhoury, 2013). 

The time period when FGC first originated is uncertain, but it is widely acknowledged that 
this practice predates both Christianity and Islam (J.A. Black, 1995) and may be over 2,000 
years old. Herodotus wrote about FGC being practiced in Egypt as early as 500 BC and the 
Greek geographer, Strabo, reported while visiting Egypt in 25 BC that one of the Egyptian 
customs was “to circumcise the males and excise the females” (Knight, 2001). Some 
scholars, citing evidence of FGC found on Egyptian mummies, have noted that FGC was 
practiced in Ancient Egypt as a sign of distinction among aristocracy (Momoh, 2005). Greek 
physicians visiting Egypt believed FGC was performed to reduce a woman’s sexual 
pleasure, thereby controlling her sexual behavior. The Romans performed a technique 
involving slipping of rings through the labia majora of female slaves to prevent them from 
becoming pregnant and the Scoptsi sect in Russia performed FGM to ensure virginity 
(Momoh, 2005). In the 19th and 20th century, within Europe and the United States, FGC 
was performed because it was believed to cure nymphomania, hysteria, masturbation and 
other “female disorders”(Momoh 2005). 


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Justifications Given for FGC 


Literature reveals that various justifications are given for the continuation of FGC by 
practicing communities. Commonly cited justifications include: 1) Religion, 2) Hygiene, 3) 
Sexual Control, 4) Culture (Identity & Marriageability) 

Religion 

WHO (2001) states that religion is proclaimed by some Muslim, Christian, Jewish and 
Animist communities as a reason for the continuation of FGC. Islamic Relief Canada (2013- 
2016) also states that religion is falsely used to encourage the practice within Islam, and 
that FGC has no religious or cultural justification. 

Amongst Islamic scholars, there is a dichotomous difference of opinion on the matter, with 
some claiming the practice is obligatory and others claiming it is acceptable, but not 
mandatory. Other Islamic scholars claim that the practice has no basis in Islam; there is no 
mention of a direct call for practicing FGC in the Quran. However, amongst Dawoodi 
Bohras, FGC is often considered to be an unspoken tradition mandated by the religious 
clergy. 

Islamic Relief Canada (2013-2016) notes that despite fatwas by leading scholars to 
condemn the practice, there are also numerous rulings that condone the so-called ‘sunnah’ 
form of FGC that may be roughly equated with Type I or Type IV. For instance, the Majelis 
Ulama of Indonesia (MUI), Indonesia’s largest Muslim clerical body, which comprises 
leading Indonesian Muslim groups such as Muhammadiyat and Nahdlatul Ulama, does not 
entirely endorse or forbid FGC, and advocates that it is a religious and constitutional right 
for Indonesians to decide for themselves. Interviewees in their study indicated that the MUI 
fatwa was the primary reason for the continuation of the ‘sunnah’ version of FGC in their 
country. 

Health & Hygiene 

Although no medical benefits of FGC have ever been proven in the academic literature, 
some proponents of FGC believe that there are positive health benefits such as FGC 
producing a clean and healthy genital area (Islamic Relief Canada, 2016). 

In some communities, female genitals are offensive to men and being infibulated is 
considered more beautiful. These justifications of aesthetics also relate to the notion that 
female genitals lack cleanliness and must therefore be removed. Myths that encourage the 
practice of FGC are that the clitoris will grow to the size of a penis or that the clitoris is a 
“man’s organ” needing to be removed. Other believed health benefits include the idea that 
FGC cures infertility, that a woman’s uncut genitalia has the power to cause blindness and 
that if the woman conceives a child, the uncut genitalia could cause physical harm, 
madness, and lead to the death of her child and husband (WHO, 2001). These justifications 
hint at the idea that FGC, even though continued mostly by women on other women 
(Mackie, 1996), may in fact be a patriarchal tradition, used to separate women and 
encourage them into a submissive gendered role within the community. 


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Sexual Control 

The literature shows that sexual control is a highly common response given for the 
continuation of FGC amongst practicing communities. According to this belief, a woman’s 
honor is connected to her sexuality and thus FGC helps maintain that honor. For instance, it 
is believed that FGC minimizes a woman’s sexual behavior prior to marriage, and ensures 
that she remains a virgin (WHO, 2001). Thus, FGC intends to define a woman’s role in her 
society by way of her sexuality, which is a form of gender discrimination (Rahman and 
Toubia, 2000). 

Interestingly, justifications of enhanced sexual relations have also been used to promote the 
practice. Islamic Relief Canada (2013-2016) found in their study that individuals who agreed 
with FGC believed that FGC enhanced sexual relations between a man and woman as part 
of the intimacy of marriage. 

Culture (Identity and Marriageability) 

Literature shows that a community’s culture also plays a significant role in the decision to 
continue FGC. For instance, in Ethiopia, 80% to 100% women and girls undergo FGC as a 
means of loyalty to their culture and faith (Ethiopian Society of Population studies, 2008). 
The maintenance of FGC preserves the cultural identity of the group. 

Social pressure by family and friends can also turn the practice into an informal or formal 
requirement for social acceptance. Some researchers also emphasized FGC’s role in the 
social construction of a woman’s identity (Dustin & Davies, 2007), stating that in some 
communities girls who are not cut are looked down upon by society. Al-Krenawi & Graham 
(1999) highlight gender construction as well, stating that social pressures created by notions 
of family honor contribute to the identity of women. It can then be understood why FGC is 
also seen by some as a marriageability requirement - a practice that raises a woman’s 
status and makes her eligible to be a wife (Mackie, 1996, 2000). 

Interestingly, however, Islamic Relief Canada (2013-2016) found that women and girls in 
Indonesia who did not undergo FGC were seen as ‘unclean’, but they did not suffer from 
negative repercussions such as difficulties in getting married or being employed. 

Physical Consequences of FGC 

Literature on FGC is steeped with information on its harmful physical effects. Medical 
complications associated with FGC have been widely documented for Type II and Type III. 
Short-term medical complications such as “severe pain, injury to the adjacent tissue of 
urethra, vagina, perineum and rectum, hemorrhage, shock, acute urine retention, fracture, 
infection and failure to heal” have been cited, whereas long-term complications such as 
“difficulty in passing urine, recurrent urinary tract infection, pelvic infection, infertility, keloid 
scar, abscess, cysts and abscesses on the vulva, clitoral neuroma, difficulties in menstrual 
flow, calculus formation in the vagina, Vesico-Vaginal Fistula, Recto-vaginal Fistula, 
problems in childbirth and failure to heal” have been noted (WHO, 2001). 


15 


Long-term effects on the mental well-being of women and girls have also been noted, such 
as fear, submission, inhibition and the suppression of feelings. Sexual complications such 
as painful sexual intercourse due to “scarring, narrowing of the vaginal opening, obstruction 
of the vagina due to elongation of labia minora and complications such as infection” have 
been noted as well (WHO, 2001). Some studies have also demonstrated that there is an 
increased risk of transmission of the Human Immunodeficiency Virus (HIV) due to 
contaminated instruments being used during the cutting; as well as due to damaged and 
disrupted tissue, wound infection, repeated reproductive tract infections, dyspareunia, and 
dry sex” (Thein, 1995). FGC can also increase infant mortality rates; death rates among 
infants increased by 15% for mothers with Type I, 32% for Type II, and 55% for Type III 
(Sanctuary for Families, 2013). 

However, little data exists on the harmful physical effects of Type I FGC as is reported to be 
practiced within the Dawoodi Bohra community - a type considered to be common amongst 
Asian FGC-practicing communities. 

The information that does exist regarding harmful medical complications of the least severe 
forms of FGC comes from anecdotal evidence and small-scale case studies. These reports 
cite bleeding, pain, discomfort, burning sensation while urinating, swelling, and infection as 
short-term complications. Long-term effects are cited as partial or total absence of sexual 
arousal during intercourse, fear of intimacy and the act of sex, as well as psychological 
concerns such as post-traumatic stress disorder, depression and anxiety (Ghadially, 1991 & 
Srinivasan, 1991). 

Islamic Relief Canada (2013-2016) suggests that the absence of demonstrable evidence on 
the negative impact of FGC amongst Indonesian women and girls could be related to the 
notion that FGC is not discussed freely in Indonesian society or amongst its women. They 
urge for further investigations into the “reported incidences of pain, fevers, and - most 
importantly - long term traumas, such as the loss of sexual satisfaction within marriage” 

(p.22). 

Interventions Used to End FGC 

Many different interventions have been attempted to stop the practice from continuing onto 
the next generation, but few have been successful. 

Health Issues Framework 

During the 1960s and 70s, women’s groups in many African nations held awareness 
campaigns regarding the harmful effects of FGC. Moreover, doctors in Nigeria, Sudan and 
Somalia began reporting in medical journals about the harmful consequences of FGC 
(Rahman & Toubia, 2000), thus beginning intervention strategies to end FGC based on the 
health issues framework. 

The framework discusses medical complications, such as severe pain and bleeding, chronic 
infections, infertility, pregnancy problems, and pain during sexual intercourse (Jaeger et al., 
2008 & Burson, 2007) as a persuasion tool against FGC. Many activists who adhere to a 
health issues framework argue that a wish for good health is recognized among all 


16 


communities and is therefore a good persuasion tactic. The health issues framework is also 
considered important when practicing communities believe there are medical benefits 
associated with the practice. 

However, advocacy efforts using a health issues framework do come with challenges. In 
fact, medical “facts” about the consequences of FGC are hard to obtain, and in some cases 
a discrepancy has occurred between these negative medical “facts” and what women 
experience in real life due to FGC. As Monahan (2007) highlights, “Critics of the strong 
rhetoric regarding the negative health outcomes of FGC point out that there is not enough 
existing data to support negative health outcomes including the impact on sexuality” (p.22). 
The potential risks of genital cutting assumed to be true in much of the literature are based 
on conclusions from data which are purely anecdotal. As a result, some researchers, aware 
of the potential falsity of the previously held health beliefs are now depending on new 
research from more methodologically sound studies to back up their health claims (Prazak 
& Coffman, 2006). 

The collection of data surrounding the health consequences of FGC has and will oftentimes 
be hampered by methodological and ethical constraints (Monahan, 2007), which can be 
expected, considering the very private nature of Female Genital Cutting. Most researchers 
have been unable to find large populations of ‘cut’ women willing to participate in studies. 
Most data in this field continues to be drawn from case studies and small samples. Even 
within these small-scale research projects, little to no research has been collected on the 
long-term health consequences of Type I or the ‘sunnah’ variety of FGC practiced most 
often in Asia (Ghadially, 1991). 

Another challenge with using the health issues framework draws on the universalism versus 
cultural relativism argument. For instance, Islamic Relief Canada’s study (2013-2016) found 
that interventions using the health framework proved most successful when the research 
and awareness campaigns came from members within the communities themselves, rather 
than from outside influences, which falls in line with the belief that practicing communities 
are wary of outside interventions not being sensitive to their cultural traditions. 

An additional barrier to the health issues framework, as depicted by Islamic Relief Canada's 
study (2013-2016), includes religious leaders and groups condemning the more severe 
types of FGC (Types II and III) based on negative health consequences, yet supporting 
‘sunnah’ (Type 1 and/or Type IV) because they differentiate between ‘sunnah’ and the more 
severe forms of FGC. The following interviewee quote indicates just such a division: 

The FGC here is not the same with the one in Africa ... I wonder why people 
make it into an issue ... If this is about pain and human rights, the males can 
protest because they too are cut. For us, the resistance against FGC is 
unreasonable especially considering how FGC has helped those women with a 
very high libido who feel difficult to concentrate in their activities because 
they get aroused easily (Islamic Relief Canada, 2013-2016, p.16). 


17 



The literature therefore demonstrates that a more thorough understanding of the medical 
implications of Type I and/or Type IV FGC is needed to combat this growing notion that 
some forms of FGC are acceptable. 

Medicalization 

FGC is usually performed by traditional practitioners. However, the literature shows there is 
a growing trend amongst some FGC-practicing communities towards having health-care 
providers perform FGC in a sterile environment, which gives the impression that FGC is 
safe. 

In 1979, in Khartoum, the capital of North Sudan, the World Health Organization financed 
the first seminar on Harmful Traditional Practices Affecting the Health of Women and 
Children. Those in attendance opposed the continuation of FGC, including attempts at 
medicalization of the practice (Rahman & Toubia 2000). In 1993, the World Medical 
Association and several other medical professional associations including the International 
Federation of Gynecology and Obstetrics (FIGO) strongly disapproved medicalization of 
FGC. In 1997, WHO/UNICEF/UNFPA released an Interagency Statement on the 
Elimination of FGC, also condemning the medicalization of the practice. In 2016, WHO 
released guidelines on the management of health complications arising from Female 
Genital Cutting, and reiterated firmly that: 

Medicalization of FGM (i.e. performance of FGM by health-care providers) is 
never acceptable because this violates medical ethics since (i) FGM is a 
harmful practice; (ii) medicalization perpetuates FGM; and (iii) the risks of 
the procedure outweigh any perceived benefit (p.3). 

Despite strong condemnation of FGC by international communities, countries like Indonesia 
have institutionalized and legitimized the practice by allowing health-care professionals to 
perform FGC. This medicalization of the practice by the government has given the 
appearance that FGC is harmless. In other words, medicalization has allowed communities 
to use biomedicine to reconstitute their traditions locally, and make sense of health 
concerns held by the international community (Christoffersen-Dev, 2005). In fact, in the last 
few years, a growing debate has occurred amongst some health professionals who urge 
that minor forms of FGC be recognized as culturally acceptable. 

In June 2016, The Economist (2016) - a prestigious British news magazine - entered this 
debate by publishing a controversial editorial condoning “mild” FGC. The editorial argued 
that since global campaigns to completely ban FGC have been unsuccessful for the past 30 
years, governments should try a “new approach” in which the “worst forms” of genital cutting 
are banned in favor of “a symbolic nick from a trained health worker”. The Economists 
editorial was met with both praise from FGC practitioners who felt validated, and firm 
condemnation from survivors, activists and international organizations who recognize even 
“mild” FGC as a form of gender-based violence. 

Human Rights Framework 

The shortcomings of the health issues framework has paved the way for a human rights 
framework (Shell-Duncan, 2008 and Christoffersen-Dev, 2005) based on the UN 

18 



Declaration of Rights that states women and children have the right to health and bodily 
integrity and freedom from torture (Dustin & Davies, 2007). In fact, FGC has increasingly 
been discussed within the framework of girls’ and women’s rights (Rahman and Toubia, 
2000) and since 1997, WHO has issued multiple joint statements with the United Nations 
Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and other 
agencies denouncing the practice of FGC (Sanctuary for Families, 2013). 

However, this framework also has a criticism, in that, proponents of FGC consider human 
rights to be a Western construct that refuses to take into account cultural relativism (Shell- 
Duncan, 2008). As Monahan (2007), Burson (2007) & Healy (2007) discuss, a growing 
debate over universal values versus cultural relativism ensues over use of this framework. 
Islamic Relief Canada (2013-2016) also noted in their study that activist groups 
campaigning from a women’s rights angle would be ineffective, as gender rights were often 
seen as “secular and pro-Western.” 

Government & Legislation 

In 2012, the United Nations General Assembly passed a landmark resolution, “Intensifying 
Global Efforts for the Elimination of Female Genital Mutilations”, calling on all states to 
enact legislation banning FGC. In fact, over the years, FGC has been explicitly and implicitly 
prohibited by an evolving framework of international and governmental laws. Yet, for 
communities who cling to FGC as a necessary cultural tradition, viewing FGC as a human 
rights violation - one that is equivalent to child abuse or sexual assault - is deemed 
incompatible. 

For instance in India, FGC could fall under the Indian Penal Code (Section 326 - causing 
grievous hurt). However, practicing communities often do not see FGC in that manner, and 
thus ignore or are ignorant of criminal laws regarding assault and physical harm under 
which FGC could fall. Thus, several countries have enacted legislation that specifically 
makes FGC a criminal offense. 

Time and time again, the literature has discussed the use of legislation as a method to deter 
the continuation of FGC within practicing communities. And it has shown that criminalization 
of FGC is considered a contentious issue, since a spectrum of opinions exist on the effects 
of legislation (Shell-Duncan, 2008). Jaeger et al., (2008) explained that legislation can be a 
useful tool to deter communities away from the practice. Mackie (1996), on the other hand, 
notes that criminalization has had no effect on reducing or eliminating FGC occurrences. 

For instance, the early 20th century brought about the first documented laws against FGC. 
In the 1900s, in Burkina Faso, Kenya and Sudan, colonial administrations and missionaries 
tried to end FGC by enforcing laws and church rules, but these initiatives proved 
unsuccessful. Instead, communities were fueled with anger at what they saw as foreign 
interference in their cultural affairs. Similarly, in the 1940s and 50s, the Sudanese and 
Egyptian governments put forth laws criminalizing FGC which also failed (Rahman & Toubia 
2000). 

Legislation has not had the desired effect of eliminating the practice altogether. In Indonesia 
where FGC is legal and medicalized, one study found that 99% of interviewees believed 
that government intervention to cease the practice would be ineffective because FGC is 

19 



viewed as a religious requirement, a social norm that is performed for the good of the girl 
(Islamic Relief Canada, 2013-2016). 

In fact, repressive enforcement of anti-FGC laws have led to some communities continuing 
the practice in secret, and/or performing the practice on girls at much younger ages to avoid 
detection, as has occurred amongst the Maasai tribe in Kenya (Matueshi, 2016). The 
ineffectiveness of legislation to cease the practice indicates that behavior change based on 
fear is not sustainable in bringing about social change. 

Additional unintended consequences noted by researchers include fear of seeking medical 
care because friends and family members could be deported if health workers report FGC 
to authorities (Monahan, 2007), and stigmatization or marginalization of women from FGC 
practicing communities because they are under constant surveillance (Swensen, 1995). 

The effects of FGC legislation need to be studied more carefully. Legislation must be 
created in such a way that unintended consequences will be minimized, which is why a 
theme of caution emerges in the literature regarding the creation of anti-FGC legislation 
(Dustin & Davies, 2007). 

Compensation for Cutters 

In some societies, performing FGC is a source of income for the cutter and their family 
(UNFPA 2007). Thus, one method of intervention - compensating cutters to not cut girls - 
has been used to deter midwives from performing the operation. The rationale behind this 
method was that since cutters earn a livelihood by getting paid for performing the operation, 
anti-FGC agencies should pay the midwives not to cut at a higher price (Mackie, 2000). 

Modernization Theory 

The modernization theory argues that through increased urbanization, education, mass 
communication, and economic development, the tradition will naturally be abandoned on its 
own (Mackie, 2000). 

Alternative Initiation Rites 

Another intervention, based on the supposition that FGC is an initiation into adulthood, 
suggests creating alternative “harm-free” initiations for young girls. Unfortunately, these 
intervention strategies have shown little to no result in the reduction of Female Genital 
Cutting because they disregard the significance FGC has for a community. For instance, 
Prazak & Coffman (2006) conducted a study on alternative initiations, the results of which 
showed a failure in retaining long-term cessation of FGC, and then stated that a closer 
inspection of the transformation of community ideology and social norms needed to be 
studied to provide an alternative ritual that could replace genital cutting. 

Social Norm Theory 

For some communities, FGC is considered a practice that must continue for the good of the 
girl. Given this reasoning, FGC can be viewed as a social norm within a practicing 
community. In short, social norms play a prescriptive role: whoever does not follow what the 
majority of people within that community are practicing is considered strange or deviant. 
Durkheim, in his work entitled The Rules of Sociological Method’, argues “it is possible to 


20 



gain exhaustive knowledge of the ‘social constraints’ of a society through a purely statistical 
study of customs, which allow one to state what majority of the people do”. (Dubois 2003: 
P-1-2). 


The practice of FGC operates as a self-enforcing social convention or social norm. The 
communities who follow FGC consider it to be a socially upheld behavioral rule and girls 
who have not undergone FGC might feel stigmatized for not having undergone it (WFIO, 
2010). This reasoning helps explain why Islamic Relief Canada (2013-2016) found that 40% 
of their interviewees claimed that even if FGC Type 1 (‘sunnah’) was found to be medically 
harmful, the community would still continue it because it was a religious requirement. 

Finding Holistic Interventions 

The literature reveals that FGC interventions must be approached through multi-sectoral, 
coordinated efforts at both the grassroots and political level. These approaches must 
incorporate cultural, religious, human rights, and health perspectives. 

The coupling of various intervention strategies ensures that interventions account for 
cultural considerations (i.e. significance of FGC to a community) through dialogue with the 
practicing communities. This in turn helps both communities and support programs reach a 
shared understanding of the community’s problems and needs and how to address them 
(Population Reports, 2007). 

The research suggests, then, that a holistic intervention would involve developing a 
collaborative, coordinated movement that prioritizes education and outreach on FGC, and 
engages faith leaders, survivors, community members, teachers, service providers and law 
enforcement in affected communities in efforts to more effectively defend the rights of girls 
and women at risk of the practice (Sanctuary for Families, 2013; Monahan, 2007; Al- 
Krenawi & Graham, 1999). 


21 



Methodology 


22 


Methodology 

Creating the Questionnaire 

This exploratory study was conducted using an online survey instrument via Google Survey 
Forms that consisted of a mixture of quantitative and qualitative questions to understand the 
meaning behind the continuation of the practice of FGC. 

The survey was divided into three sections: 1) General Information, 2) Personal Experience, 
and 3) Social Experience. The full list of questions can be found in Appendix A. 

The General Information section contained questions concerning the demographic data of 
participants such as age, education level, religion, country of residence, etc. These 
questions were asked to determine the demographic similarities between research 
participants. Secondly, questions related to personal and social experience were asked to 
determine participants’ knowledge and experience of FGC within their communities. 

In order to develop these survey questions, Sahiyo consulted with various FGC experts and 
NGOs, as well as reviewed the sources referenced in the literature review and created 
questions based on surveys/questions used within these studies. Other resources were 
referenced too, such as Sahiyo co-founder Mariya Taher’s Master’s thesis at San Francisco 
State on the topic of FGC in the Dawoodi Bohra community within the United States. Her 
thesis was consulted to guide the wording of specific questions pertaining to the practice of 
khatna within the Dawoodi Bohra community. Additionally, the researchers, as natives in the 
Dawoodi Bohra community, had knowledge of the population which helped shape some of 
the questions. 

This survey was not translated into another language. However, some of the questions 
included words that were more familiar to the target population, such as ‘khatna’, a more 
culturally sensitive word for the term Female Genital Cutting. Though no translation services 
were needed, some participants chose to respond to qualitative survey questions using 
words in Gujarati or Lisan al-Dawat (the language spoken by Dawoodi Bohras). In these 
situations, the researchers, being able to speak Gujarati or Lisan-al-Dawat, translated the 
words when collecting the data. (Refer to the glossary for meanings of Gujarati or Lisan-al- 
Dawat terms.) 

In order to test for reliability and validity of the instrument, Sahiyo asked fellow FGC experts 
and NGOs to read through the set of questions to assess for bias and to make sure the 
questionnaire was a culturally acceptable tool for the exploratory study. Additionally, to 
check for clarity of wording and bias in wording, the survey was first tested on ten people. 
After making necessary changes based on their feedback, the survey was released to the 
Dawoodi Bohra community through snowball sampling methodology. 

Ethics and Confidentiality 

There were no physical or psychological risks related to this study, however there was the 
possibility that some questions in the survey would make participants feel uncomfortable. 

23 


Participants were given written instructions regarding what participation in the survey meant 
before beginning the survey. Only women who belonged to or grew up in the Dawoodi 
Bohra community, and were 18 years or older, were allowed to participate in the survey. 
Survey participants were also reminded that the survey was anonymous and completely 
voluntary. They were not obligated to answer any questions and were free to stop the 
survey at any time. Participants read through instructions and checked “yes” to questions 
asking if they understood these instructions and gave permission to use their responses in 
our study (See Appendix A). 

Another potential risk was loss of privacy. This risk was minimized by keeping the research 
data in a secured database that only researchers had access to. To ensure anonymity of 
the participants, no identifying information, such as names or email addresses, were asked 
in the survey. 

Sampling 

Sampling Strategy & Recruitment Process 

Jonah Blank (2001), in his research of Dawoodi Bohra rituals, had great difficulty in 
gathering information on the practice of FGC. In the passage below, he explains how his 
position of being outside the community affected his access to this information. 

Whether the custom is extinct, extremely rare, or still widely practiced, it is a 
topic on which no male researcher (particularly one outside the community) 
can speak with real authority. An issue of such seriousness, however, would be 
an important area for investigation by a sensitive researcher, particularly a 
female community member (p.57). 

The Dawoodi Bohra sub-sect is a very closely-knit community that generally disapproves of 
inter-marrying with other ethnic/religious groups because they are considered outsiders. Not 
surprisingly then, many religious practices are considered private and outsiders are also not 
allowed to partake in the knowledge of these traditions. However, as Blank (2001) states, a 
female researcher from within the community may be able to gather information on the ritual 
of FGC. Since the Sahiyo researchers are female and were raised in the Dawoodi Bohra 
community, access to this community was possible as the research in regards to the 
practice of khatna was conducted in a sensitive manner. 

As no large-scale study existed on the practice of ‘khatna' amongst the Dawoodi Bohra 
community, purposive sampling and snowball sampling methods were used to recruit 
participants to take the exploratory, online survey. First, the researcher identified ten 
members of the community who would be willing to take the survey (purposive sampling). 
These participants received an email or WhatsApp message describing the research study 
and asking them to take part. The recruitment script for this e-mail/WhatsApp message is 
listed in the Appendix B. Then Sahiyo researchers asked those initial survey respondents to 
identify other women who were 1)18+ and 2) raised in the Dawoodi Bohra tradition, to take 
the survey. These women then sent the survey e-mail or WhatsApp message to their own 
networks. This method of identifying participants continued for six months, from July 25, 


24 


2015 until January 25, 2016 and in the end, 408 women had responded to the survey 
(snowball sampling). 

Sample Size 

Sahiyo’s initial goal was to have 100 women complete the survey. However, as word of the 
online survey spread through the Dawoodi Bohra community, more and more participants 
were identified, culminating in 408 women completing the survey during a period from July 
25, 2015 until January 25, 2016. After sorting through data for ineligible participants, Sahiyo 
found a sample size of 385 women from which to extrapolate data and analyze for purposes 
of this exploratory study. Ineligible participants included those who 1) did not give consent 
to using their answers in our survey, 2) did not give permission to publish results, 3) stated 
they did not grow up in Dawoodi Bohra community, 4) identified as male. 

Gathering Data 

The researchers conducted the study using quantitative methods involving survey research. 
Data collection involved survey information in which demographic questions as well as both 
open- and close-ended questions were asked of participants. Sahiyo researchers worked 
with a population that spoke English, therefore, no interpreter was needed for the survey 
tool. All survey questions asked to participants were in English. In instances when 
participants reported using Lisan-al-Dawat or Gujarati words, researchers were able to 
translate them since they are natives in the community and speak the language. No other 
persons were involved in the collection of survey materials. However, since the researchers 
did employ a snowball method to obtain research participants, the participants themselves 
helped in gathering data by referring the researchers to additional members of the 
community willing to participate in the study. In order to record data from the survey, Google 
Survey Forms was used to capture survey results and to transfer to a Google Spreadsheet 
with a timestamp date of when the survey was taken by the participant. 

An online method of data collection was deemed appropriate, as (Blank, 2001) observed, 
the Dawoodi Bohras, “have become Internet pioneers uniting members of their far-flung 
denomination into a worldwide cyber congregation” (p.178) and “the latest technological 
device in the Bohra toolbox is the Internet” (p.178). Blank found that computer ownership, 
use and literacy were far more prevalent in the Dawoodi Bohra community than in most 
others segments of Indian society (2001). 

Organizing and Interpreting Data 

Researchers analyzed the data using both quantitative and qualitative content analysis 
methods. 

Quantitative data analysis presented in this report was performed using R, a free statistical 
computing software package. Differences in estimates were calculated using chi-squared 
tests of independence, with an alpha of 0.05. Given small sample sizes for subpopulations, 
exact Fisher test were also employed. All estimates are unweighted. 


25 


Qualitative data analysis helped answer the following research questions: 1) Why FGC is 
practiced among Dawoodi Bohra women, and 2) What were the physical, psychological, 
and sexual impacts of undergoing FGC. After survey data was collected, Microsoft Word 
was used to conduct content analysis by way of coding and subcoding recurring themes 
found within open ended questions. First, to generate open codes, the researcher 
conducted a line-by-line analysis to identify key words from survey participants’ responses. 
Then, sentences that appeared to form part of a meaning unit were identified and codes 
were developed. Next, key ideas/themes were identified and codes were refined and/or 
additional codes were created. Once a final set of coding was completed and similar codes 
were grouped into broader categories, theoretical constructs were identified, from which 
emerging theories were developed (Grinnell & Unrau, 2008). 

Survey Limitations 

Limitations of the study include participants being gathered via the snowball method, which 
eliminates the possibility of participants being randomly chosen from a sampling frame. 
While this limits the ability to generalize about ‘khatna’ within the wider Dawoodi Bohra 
community, these results provide the first look into a hard-to-reach population. Based on the 
unique population studied, snowball sampling was deemed most appropriate (Heckathorn, 
1997). 

Additionally, only those with computer, mobile or Internet access and capability, and 
knowledge of English, were able to take part in the survey. This reduces the generalizability 
of study findings across socio-economic levels, particularly amongst Dawoodi Bohras in the 
lower income brackets who do not speak English or have no access to computers or the 
Internet. Both of these issues - the snowball sampling technique and the web-only 
administration - introduce bias into the results. 

Conclusions made in this report are best considered as suggested trends that warrant 
further research and more sophisticated data collection techniques, including respondent- 
driven sampling to estimate representative weights. 


26 


Key Findings 


27 


Key Findings 

This exploratory study consists of a mixture of quantitative and qualitative questions to 
understand the practice of Female Genital Cutting. The survey was divided into three 
sections: 1) General Information, 2) Personal Experience, and 3) Social Experience. The full 
list of questions can be found in the Appendix. 

General Information 

Towards the start of the survey, demographic information was collected to establish 
commonalities and differences between survey participants and to ensure eligibility 
according to study guidelines. In addition, the information was collected to determine if 
demographics correlated with participants’ view on FGC and its continuation. Sample size 
consisted of 385 women who identified as having grown up in the Dawoodi Bohra 
community. Demographic information is depicted by charts below: 

Q1 : Ages of Participants 

The majority of our participants fell between the ages of 18- 45 (87%). The remaining 13% 
of participants were 56 years and older. 


3% 



How old are you? 

(n=385) 

11 % 


66+ years 
56-65 years 
46-55 years 
1 36-45 years 
26-35 years 
1 8-25 years 


28 


Q2: Education Level 

Eighty percent of respondents have earned at least a bachelor's degree, which is not 
representative of the general education levels worldwide (or even in the countries 
represented in the survey). This may be affected by the methodology - 80% of those 
surveyed have earned at least a bachelor’s degree as compared to 22% among countries 
belonging to OECD countries. 1 

Education level 

(n=385) 

Some Post-graduate degree 
(MD, JD, Masters or Ph.D) 

Completed Graduate degree 
(B.Sc, B.A, etc.) 

Some Graduate degree 
(B.Sc, B.A, etc.) 

Completed Secondary 
school (8-12) 

Some Seconary 
school (8-12) 

Some Primary and middle 
school (KG-7) 



Q3: Marital Status 

The majority of participants were married at 76%. The second largest group was 1 8% 

s ' n 9' e ' Marital status 

(n=385) 



Other 

Widow 

Separated 

Divorced 

Married 

Single 


1 OECD countries are those 35 member countries who have signed onto the Convention on the Organisation for 
Economic Co-operation and Development. Countries include: Australia, Austria, Belgium, Canada, Chile, Czech 
Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, 
Korea, Latvia, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, 
Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States 


29 





Q4: Current Income Level 

As the survey was distributed globally and income levels vary country to country, 
participants were asked to self-report their income levels. 


50 

40 

30 

20 

10 

0 


Income group participants currently 
belong to 

(n=385) 


AZ°L 



Low Lower-middle Middle Upper-middle High 

income income income income income 


Q5: Previous Income Level 

Survey participants were asked to self-report the income level of the household they grew 
up in as children. 


Income groups participants grew up in 

(n=385) 

50 48% 



Low Lower-middle Middle Upper-middle High 

income income income income income 


30 


Q6: Previous Religion 

Survey eligibility requirements included that all participants grew up in the Dawoodi Bohra 
community, thus only participant responses from those who indicated they had grown up in 
this community were used for data analysis. 


Q7: Current Religion 
Sixty-nine percent of participants 
still identified as Dawoodi Bohra. 
Twenty-six participants choose 
the “other” category and 
responses included: Muslim, 
Islam, Bahai, Spirituality, None, 
Agnostic, Atheist, Humanitarian, 
Sahaj Yoga, “practice with all 
sects”, and “following the 
teaching of my grandparents”. 


Religion participants identify with now 

(n=385) 




Other 

Other Shi'a sect 
Sunni Muslim 
Non-practising 
Dawoodi Bohra 


Q8: Profession 

In line with their high education levels, most survey participants held a profession or worked 
part-time (80%). Twenty percent of survey participants indicated they did not work, marking 
the homemaker/housewife category. 


Of the 46 participants 
or 12% of survey 
respondents who 
indicated the “other” 
category, all 

indicated belonging 
to a profession 
outside of the home. 
Other categories 
included: social 

work/NGO, 
academia/teacher, 
marketing, writing, 
finances, human 
resources, counselor, 
IT, journalism/media, 
conservator, event 
planning, graphic 
design, artist, 

architect, city 

planner, life coach. 


Profession 


Other 

Administrative 

Engineer 

Student 

Legal field 

Business woman 

Healthcare 

Teacher 
Homemaker/housewife 
+ Business from home 
Homemaker 


12% 



20% 


0 


10 


15 


20 


31 


Q9: Current Country of Residence 

Majority of participants resided in India (131 participants or 34%), followed by the United 
States (119 participants or 31%), United Arab Emirates (9%), United Kingdom (8%), 
Pakistan (6%), Canada (5%), Australia (3%). 


Countries participants currently reside in 

(n=385) 


Country 

Number 

India 

131 

United States 

119 

United Arab Emirates 

36 

United Kingdom 

29 

Pakistan 

22 

Canada 

18 

Australia 

10 

Tanzania 

4 

Kuwait 

3 

Malaysia 

3 

Kenya 

2 

Oman 

2 

Bangladesh 

1 

Uganda 

1 

Bahrain 

1 

New Zealand 

1 

Qatar 

1 


32 


Personal Experience - Part 1 

The next set of questions represent participants’ own experience with the Dawoodi Bohra 
community and awareness of FGC within the community. 

Q10: Socializing With Other Dawoodi Bohras 

Participants were asked to indicate how often they socialized with other Dawoodi Bohras to 
determine if socialization had influence on whether or not a person underwent FGC or 
continued FGC on their daughters. The majority of participants indicated they socialized 
with other Dawoodi Bohras at least every couple of weeks. 

Do you socialize/interact with other Dawoodi Bohras 
on a regular basis 

(n=385) 

Not at all 1 1% 


Almost never 
(onece or twice a year) 



8% 


Hardly 

(Every couple of months) 



23% 


Sometimes 
(Every couple of weeks) 

Regularly 

(A couple of times per week) 



Q1 1 : Awareness of Khatna 

Survey participants were overwhelmingly aware of the continuation of FGC in the 
community with 377 survey participants (98%) stating “yes” and 8 survey participants (2%) 
stating “no”. 

Are you aware of prevalence of FGC in 
DB community? 


2 % <"= 385 > 



Q12: Friends or Family Members Who Underwent Khatna 


Of the 385 survey 
participants, only 19 
women or 5% were 
unaware of FGC 
occurring amongst their 
friends or family 
members. In total 88% 
knew a family member 
on whom FGC was 
performed and 56% 
knew a friend on whom 
FGC was performed 


Do you have friends or family members on whom 
Khatna was performed? 



Q13: Khatna Performed on Mother 

Eighty-one percent or 31 1 survey participants responded that FGC had occurred to their 
mother and 4% responded that FGC had not occurred to their mother. 


Was Khatna performed on your mother? 

(n=385) 



Fifteen percent do not know 
whether FGC was performed 
on their mother. Knowledge 
of mother’s FGC procedure 
was found to be related to 
whether the respondent 
personally had FGC 
performed on them. Those 
who had experienced FGC 
were more likely to know if 
their mother had undergone 
the procedure - 88% versus 
51%. 


34 





Q14: Khatna Performed on Survey Participant 

Eighty percent or 309 survey participants responded that they had undergone FGC. While 

Was Khatna performed on you? 

(n=385) 


20% or 76 survey participants 
reported they had not 
undergone it. 


No relationship was found when 
the data was analyzed to 
determine if a relationship 
existed between income levels 
(Question #4) and having 
undergone FGC, nor was a was 
a relationship found when 
comparing education levels 
(Question #2) to having 
undergone FGC. 



Additionally, no significant statistical difference was found when the amount of socialization 
within the Dawoodi Bohra community (Question #10) was compared to whether or not a 
person had undergone FGC. Results are shown below. 


40 

35 

30 

25 

20 

15 

10 

5 

0 


Amount of socialization in DB community 
vs. percentage of undergoing Khatna 



Never/Almost Hardly Sometimes Regularly 
never 


However, data analysis did reveal a significant differences between the reported FGC rates 
across age groups (Question #1). Ninety-two percent of those 46 years or older reported 
undergoing FGC, compared to 68% of those 18-25 years of age. 



1 8-25 years 26-35 years 36-45 years 


46+ years 


35 


Personal Experience - Part 2 


The following questions were asked of the 309 survey participants who indicated they 
underwent FGC, so that we could gauge their own understanding of what had occurred to 
them. 


Q15: Age of Khatna 

Two hundred and five or 
66% of respondents 
stated they underwent 
FGC between 6 to 7 
years of age which is the 
considered the normal 
age to undergo it by the 
Dawoodi Bohra 

community. Eighteen 
survey participants or 6% 
could not recall how old 
they were when they 
underwent FGC. 


Age of participants at the time of Khatna 

(n=309) 





13 % 




I don't know 
1 2+ years 
10-11 years 
8-9 years 
6-7 years 
0-5 years 


Q16: Decision Maker of Khatna 

Survey Participants were asked to mark all choices that applied to Question #16. The Table 
below represents all answers marked by participants. 


With respect to who made the decision to have FGC done, which was a multiple response 
question, 67% of respondents indicated that their mother made the decision. Thirty-two 
percent indicated that another female family member was involved in the decision making, 
which included grandmothers. And 23% indicated some other decision maker, which 
include fathers, religious leaders, and their wives. 

Who made the decision? 


I don't know 

Wives of religious 
leaders 



61 


Religious leaders 

Mother and father 

Other male family 
members(s) 

Father 

Other female family 
members(s) 

Mother 



0 50 100 150 


36 


200 



Where the FGC was performed? 

Country 

Number 

India 

217 

Pakistan 

44 

United States 

10 

Tanzania 

9 

United Kingdom 

7 

Kenya 

6 

United Arab Emirates 

5 

Kuwait 

3 

Sri Lanka 

2 

Canada 

2 

Bangladesh 

2 

Bahrain 

1 

Malaysia 

1 


Q17: Country Khatna 
Occurred In 

Most survey respondents 
reported that they underwent 
FGC in India (70%). Forty-four 
respondents stated that they 
underwent FGC in Pakistan 
( 14 %). 


Q18: Taken Out of Country to Have Khatna Done 

The majority of respondents (86%) reported that they had FGC done to them in their 
country of residence. Eleven percent or 34 respondents reported being taken out of their 
country to have FGC done. Data Analysis was unable to compare ‘where FGC was 
performed’ (Q17) with whether the woman was outside her native country (Q18) due to a 
low number of participants or cell sizes (i.e., under 5 participants) for some of the countries 
listed in Q17. 

Taken out of the country 

(n=385) 



37 


Q19: Location of Khatna 

The majority of respondents (86%) had FGC done in a private residence, while 12% 
reported having undergone it in a health facility. 

Facility where Khatna was performed 

(n=309) 

Other 1 2% 


Private residence 
(Home) 



86% 


Hospital/ 
health clinic 


0 20 40 60 80 100 

Data Analysis also revealed that there were significant differences in regards to what facility 
FGC was performed in according to the country where the survey participant underwent the 
procedure. In Pakistan, 100% of survey participants had the procedure done at a private 
residence. In India, 88% of survey participants had the procedure at a private residence. 
Because of the small sample cell size, the United States and the United Kingdom were 
combined (17 women), and data analysis here revealed that 60% of survey participants had 
the procedure done at a private residence. 

Facility where Khatna was performed vs. Country where 
Khatna was performed 

(n=261) 


Hospital/ 

Health clinic 

Private residence 
(Home) 


India Pakistan USA/UK 

(21 7 women) (44 women) (17 women) 


80 

60 

40 

20 

0 




38 






Q20: Who Performed Khatna? 

Seventy-four percent of women reported being cut by a traditional cutter. Fifteen percent in 
total reported being cut by 

a health professional. By whom was Khatna performed? 

(Breakdown: 9% general (n=309) 

practitioner/family doctor; 

5% gynecologist, 1% 
nurse.) Another 5% were 
unsure who cut them. The 
remaining 6% of 
participants marked the 
‘other’ category, and their 
elaborations indicated that 
they were cut not by health 
professionals, but other 
women belonging to the 
Dawoodi Bohra 

community. 



Q21: Type of “Cutting” Performed 

Typically, in the Dawoodi Bohra community, the practice of FGC entails that only part of the 
clitoral hood is removed. The World Health Organization has classified this type of cut as 
Type 1 genital cutting, which includes the removal of the prepuce with partial or total 

removal of the 
clitoris (2016). 

The majority of 
survey respondents, 
however, were 
unsure of what had 
occurred to them, 
with 65% or 202 
participants 
answering ‘I don’t 
know’. Among the 
rest, 21% 

responded that part 
of their clitoral hood 
had been removed. 
Five percent 

reported that all of 

their clitoral hood had been removed, and another 5% reported that their clitoral hood and 
part of their clitoris had been removed. Three percent reported that their entire clitoris had 
been removed. The other category includes three responses in which two participants did 
not respond and one participant reported that her labia was cut as well. 


Type of FGC performed 

(n=309) 

Other 

I don't know 

Clitoral hood and 
all of clitoris removed 
Clitoral hood and 
part of clitoris removed 
All of clitoral head 
removed 

Part of clitoral hood 
removed 



39 






Q22: Narrative Question - Experience about their Khatna 

Participants were asked to describe the details surrounding their FGC. To analyze the 


Table 1 : Elements of Story (FGC experience) 


# of participants 

Story element 

112 

Taken to cutter's house/cutter 
came to their house 

60 

Taken by Mother/grandmother/ 
other female relative 

45 

Underwear taken off 

50 

Pinned down by women 

41 

Razor/blade/knife/scissors/wire 

used 

12 

Black powder/turmeric/something 
put on afterwards/red color 
antiseptic (known as Lai Dawa)/ 
diluted dettol 

12 

Wore a pad/cloth afterwards 

10 

Given a treat afterwards 

6 

Rested in bed afterwards 

12 

Had it done with a friend/cousin 

10 

Health professional did it/ 
medicalization 

8 

Social Pressure to have it done 
to daughter 


responses, content analysis was 
carried out and recurring themes 
were coded and sub-coded. Charts 
below depict coding system. Of the 
385 survey participants, 309 women 
had undergone FGC. Within this 
group, 131 women provided details 
on their FGC experience. 

Four themes emerged from 
participant responses: 1) Discussing 
the elements of their FGC 
experience, 2) Discussing what they 
were told was going to happen to 
them, 3) Discussing their physical 
reactions, and 4) their emotional 
reactions. Breakdowns of each theme 
are depicted by the tables below. 

Of the most significant narrative 
themes, the follow figures stood out: 

• 86% of women described 
being taken to a cutter or a cutter 
coming to their house. 

• 98% of women described 
experiencing pain immediately after 
FGC. 

I 


Table 2: What they were told was going to happen to them 



Deception about what 

was going to happen Secretive 

No explanation Removing a 
provided worm/insect 

All bohra girls 
go through it 

Genitals being 
dirty 

# of participants 

50 

26 

28 20 

6 

2 

Table 3: Physical reactions 


Don't remember (not completely 

Couldn’t walk afterwards/ 


Pain clear)/blacked out at some point Blood Screamed sit for toilet/pain while urinating 

# of participants 

50 

26 

28 20 


2 

Table 4: Emotional reactions 



Terrible/horrible/ 

Realizing what happened 

Mention that they didn't 


Traumatized 

scary experience 

to them later in life 

Anger want it for daughter 

# of participants 

49 

41 

19 

16 

12 



40 


Q23: Physical or Health Complications 

Participants were divided between not having any health issues immediately after FGC 
(40% or 123 participants stated as such) and not being able to remember if they faced any 
physical or health issues (37% or 112 participants). Twenty-three percent responded that 
they had undergone physical and health issues immediately after undergoing FGC. 

Did you face any physical or health issues 
immidiately after Khatna? 

(n=309) 


I don't remember 

No 

Yes 



Of those who reported undergoing physical or health issues immediately after FGC, 71 
respondents provided information regarding what physical/health effects they immediately 
encountered. Their information is depicted by Chart 23b. 

Immidiate health effect after Khatna 

Respondents who said "Yes” 

(n=7i) 


Fever 1 1% 
Loss of sensation 1 1% 



41 


51% 


Q24: Mental State Immediately After Khatna 

Survey participants were asked to mark all answers that applied to them. Overall, 29% did 
not remember what 

they were feeling Mental state immidiately after Khatna 

following the 

procedure. The most I 

common emotions 
were fear (51%), 

anger (21%), and Anger 21% 

sadness (15%). Three 
percent felt happy and Sad 

8% were ambivalent. 

Other responses 
included: Confusion, 
shame, numbness, 

humiliation, despair, Ambivalent 8% 

mistrust or betrayal, 
normal, and Don't I 

traumatized. remember I 


15% 


Happy ■ 3% 


I 


29% 


0 


10 


20 


30 


40 


50 


60 


Q25: Emotional Impact on Adult Life 

About half of the 309 participants responded that FGC had left an emotional impact on their 
adult life (48% or 149 participants). The other half (50% or 154 participants) reported not 
having experienced an emotional impact on their adult life. 


Did FGC leave emotional impact on adult life? 

(n=309) 

2 % 



42 


Of the 149 survey participants who stated that undergoing FGC had created an emotional 
impact on their adult life, 77 people provided descriptions of that impact. Their responses 
were coded in the following way as depicted by Chart 25b. 


Emotional impact on adult life 

(n=149) 


Impact Percentage of participants 


Haunted by FGC memories 

8 

Betrayed/violated/distrust in 
family 

9 

Upset/Disappointed/ 

disturbed 

9 

Shame/embarassed/ 

humilated 

5 

Fear/scared/nervous 

5 

Feeling incomplete/ 
something missing 

9 

Don't want others to go 
through it 

5 

Too young to consent/ 
understand 

8 

Anger at parents 

6 

Anger 

19 

Sexual frustration 

17 


43 


Q26: Khatna and Sex 
Life 

Thirty-five percent of 
respondents reported that 
FGC had affected their sex 
life. Another 23% reported 
that their sex life had not 
been disturbed. Thirty-two 
percent of respondents 
were unsure if FGC had any 
impact on their sex life. Ten 
percent of respondents 
were not sexually active at 
the time of taking the 
survey. 


Has Khatna affected your sexual life? 

(n=309) 





Other 

I am not 
sexually active 

I don't know 


No 



Yes 


Q27: Khatna and Sex Life - Positive or Negative 

Of the 108 participants who responded in Question #26 that FGC had affected their sexual 
life, the following question of if FGC had affected their sexual life positively or adversely was 
asked. Ninety-four participants (87%) indicated that their sexual life had been impacted 
negatively. Eight participants (7%) responded that their sexual life been positively affected. 

If Khtana affected sex life, is it positively or adversely? 

Respondents from Q26 
(n=l08) 

Left answer 1 3% 
blank I 

Unsure 1 3% 


Adversely 



Positively 7% 


i 


20 


40 


60 


80 


100 


44 



Q28: Narrative Question - Khatna and Sex Life Details 

Participants were asked to describe the details surrounding the effects of FGC on their sex 
life. To analyze question, content analysis was carried out and recurring themes were 
coded and subcoded. Eighty-three people responded to this question with more description. 
Chart below depict coding system. 


If you wish to elaborate on the effects of Khatna on 
your sexual life, please describe below 

(n=38) 


Effects 

Percentage of participants 

Heightened physical 
stimulation 

83 

Increase in sexual desire 

3 

Didn't affect sexual life 

3 

Unsure if related to procedure 

10 

Negatively affected relationship 

7 

Low libido 

10 

Discomfort/pain 

17 

Lack of physical stimulation 

19 

Difficulty/inability ro reach an 
orgasm 

29 


45 


Social Experience 

Q29: Perception of Not Undergoing Khatna 

Participants were asked what their relatives and friends would think of women who have not 
undergone FGC, and were allowed to mark more than one answer to the question. The 

graph below depicts the overall 
number of times an answer was 
selected by a participant. 
Seventeen participants also 
selected “other”, and of these 
seventeen “other” responses, 
eleven individuals indicated that 
different groups (family vs. 
friend, educated vs. 
uneducated, religious vs. not 
religious) would think different 
things of a woman who hadn’t 
undergone FGC. Additionally, 
this graph depicts the overall 
percentage of selection for an 
answer response by survey 
participants. The leading 
response selected by 
participants was “We don’t 
discuss Khatna”. 


Q30: Explanations Given to 
Perform Khatna 

Multiple explanations were given as to 
why FGC continued in the community. 
Participants were able to mark all of the 
explanations they had heard for the 
continuation of FGC. The most common 
answer was that FGC was continued for 
religious purposes. Those who marked 
“other” indicated that they had heard no 
explanation for FGC. 


Explanations heard for Khatna 

Explanations Number 

Other 12 

As a necessary requirement 36 

for a good marriage 

To gain respect from the 32 

community 

To increase sexual arousal 8 

To decrease sexual arousal 1 78 

To maintain traditions and 1 61 

customs 

For reasons of physical 1 03 

hygiene and cleanliness 

For religious purposes 222 


What would DB relatives and friends think if a 
woman did not undergo Khatna? 


Participants who responded 


Number 

Percentage 

Other 

17 

6 

1 don't know 

74 

19 

We don't discuss Khtana 

198 

45 

The woman is not a "true" 
Dawoodi Bohra 

102 

27 

They would think that the 
woman was unclean 

41 

11 

Wouldn't want that woman 
to marry their son 

45 

11 

They would be upset 

42 

11 

They would be very 
surprised 

79 

21 

They would think nothing 
of it 

63 

16 


Q31 : Men’s Knowledge 
on Khatna 

Participants were asked if 
men (fathers, brothers, sons, 
etc.) were aware of FGC. 
The majority (72%) reported 
yes. 


Are men aware of khatna? 

(n=385) 



I don't know 

No 

Yes 



Men's expectation on Khatna occurring 

(n=385) 



Q32: Men’s Expectation of 
Khatna Occurring 

The majority of survey respondents 
(45%) were unsure if men expected 
FGC to be performed on Dawoodi 
Bohra women. Thirty-eight percent 
believed that men did not expect 
FGC to happen to women. 


Q33: Men’s Knowledge of Khatna When Female Relatives Undergo It 
Though 72% of participants responded that they believed men are aware of FGC in 
Question 31 , 39% were unsure if men were told of the practice when it occurred to a female 
relative and 34% believed that men were not told when it occurred to a female relative. 

Are men told of the practice when it happens? 

(n=385) 



I don't know 

No 

Yes 



47 



Q34: Continuing Khatna on Their Daughter 

Eighty-two percent of participants overwhelming responded that they would not continue 
FGC on their daughter. 


Would you continue Khatna on your daughter? 

(n=385) 




Most likely 
Likely 
Undecided 
Unlikely 

Extremely unlikely 


Data analysis also revealed a significant statistical difference between respondents’ 
reporting they are OK with khatna continuing and whether they identified with being a 
Dawoodi Bohra in their adult life. Those most likely to continue khatna were also more likely 
to still identify as Dawoodi Bohra. The same relationship was found when anlayzing the 
question on if they would continue the practice on their own daughters. Chart 34a shows, 
two-thirds of those still identifying as Dawoodi Bohra were extremely unlikely to continue the 
practice with her daughter, while 96% of those who have left the religion say the same. 


Identification with DB vs. being okay with 
Khatna continuing 

(n=385) 


1 am ok 

|l% 



7% 

1 am slightly 

0% 

ok 

4% 

1 am unsure 

| 3% 



Dawoodi Bohra 

All other religions/ 
non-practicing 



0 20 40 60 80 100 


48 




Q35: Khatna Continuation in the Community 

Participants were asked to depict how they felt about the practice of FGC continuing using a 
scale. Three hundred 
and twenty eight or 
85% of participants 
reported not being 
okay with FGC 
continuing. Only 28 
participants or 7% 
reported being ok with 
the practice 

continuing. 

The data showed that 
there was a 
relationship between 
FGC prevalence and 
the intention to 
continue the practice 
with one’s offspring 

(Question #34) and also in general in the community. Among those who had not undergone 
FGC, no one stated that they were “OK or slightly OK with the practice continuing”; only 
10% of those who had experienced FGC reported being OK or slightly OK with continuing 
the practice in the community (and 9% reported being OK or slightly okay with continuing 
FGC on their own daughter). 

Data was also analyzed to see if survey participants’ attitudes towards abandoning FGC 
changed with participant’s age group. Coincidentally, older women, 46+ years were more 
likely to express a negative view of FGC continuing (93%) compared to women 25 years 
and younger (70%). 


How do you feel about Khatna continuing? 

(n=385) 


am ok 



I am slightly 
ok 

I am unsure 


81% 


I am slightly 
not ok 

1 1 am not ok 


Attitude towards FGC by age group 




Not ok/ slightly 
not ok with 
Khatna 
continuing 

Unsure or okay 
with Khatna 
continuing 


49 



Q36: Belief around Prevalence of FGC in Community 

Participants were asked to estimate the percentage of females who had undergone FGC in 
the entire Dawoodi Bohra community. The chart below indicates that the majority of 
respondents believe FGC to be prevalent at a rate of 61% to 100% within the Dawoodi 
Bohra community. 


200 


How prevealent is Khatna in DB? 

(n=385) 


153 



1-20% 21-40% 41-60% 61-80% 81-100% 


Q37: Khatna Performed Amongst Other Communities in India 
Survey participants were asked if they were aware of FGC happening in other Indian 
communities. The majority reported no. Fifty-nine respondents responded yes, and few 
respondents provided names of religious communities in India, including: Memon, Agha 
Khanis, other Shia Muslims, Sunni Muslim, Hindus, Christians, Sulaimani Bohras, Alvi 
Bohras, and the Siddi tribe in Pakistan. 

It is important to note that this information in regards to other South Asian communities 
practicing FGC has not been confirmed independently by Sahiyo. However, Ghadially 
(1991) interviewed cutters from the Dawoodi Bohra community who stated they had clients 
from Aliya and Sulemani Bohra Muslim communities as well. The Dawoodi Bohras, the 
Aliyas and the Sulemanis were considered one Bohra sect before they split into sub-sects in 
the 1600s. All three claim their roots in Ismali Shia Islam. 


50 


Discussion 


51 


Discussion 


Currently, no representative data on FGC exists for India or amongst Dawoodi Bohra 
communities worldwide. However, the practice of Female Genital Cutting (FGC) among 
Dawoodi Bohras has been the subject of small-scale research and documentation for more 
than two decades. One case study, published in April 1991 by Sandhya Srinivasan, 
depicted a young mother living in an extended household who, because of pressure from 
her mother-in-law, took her seven-year-old daughter to a traditional cutter to have her 
undergo FGC. Another well-known study of FGC in the community is ‘All for Izzat’ by 
Rehana Ghadially (1991). Her study was based on oral interviews with 50 Dawoodi Bohra 
women from Mumbai, as well as two traditional cutters. A more recent small scale study 
based on ethnographic interviews of six women who underwent FGC and resided in the 
United States was conducted by MSW student and Sahiyo co-founder, Mariya Taher 
(2010). Though limited in scope, these case studies help corroborate results found by 
Sahiyo’s 2015-16 study, providing for the first time an evidence-based understanding of 
how FGC has continued within the Dawoodi Bohra community at a global level. 

Sahiyo’s 2015-16 study also supports findings by Shell-Duncan, Reshma, Feldman-Jacobs 
(2016), who produced a state-of-the-art synthesis on FGC by combing through nationally 
representative data on the prevalence of the practice among girls and women ages 15-49 in 
29 countries (Yemen, Iraq and 27 African nations). Lastly, the analysis looked at findings 
from Islamic Relief Canada’s (2016) qualitative study on FGC in Indonesia to help 
demonstrate similarities between varying Asian countries in regards to the type of FGC 
performed. 

Type of FGC 

Ghadially reported that the Dawoodi Bohras practice the ‘sunnah’ variety of FGC in which 
the prepuce or the tip of the clitoris is removed. However, Sahiyo’s study showed that the 
majority of survey participants (65%) were unsure of what occurred to them, indicating that 
the exact type of cut was not revealed to them at the time they underwent FGC. Only 21% 
of survey respondents indicated that a part of their clitoral hood had been removed. 

Islamic Relief Canada (2016) indicated a similar finding amongst their survey population in 
Indonesia regarding a lack of knowledge on the female anatomy amongst survey 
participants, indicating that 60% of their interviewees in Lombok had limited knowledge of 
the anatomy of the female body and its reproductive organs - and were therefore unaware 
of what FGC entailed and how it affected their bodies. 

Age of FGC 

Consistent with Ghadially’s findings that khatna was performed on girls at the age of seven, 
66% of Sahiyo’s survey respondents indicated that they underwent FGC between six to 
seven years of age. Sahiyo’s survey did not inquire as to why girls were cut at this age, but 
Ghadially postulated that it was perhaps because the girl was considered too young to 


52 


understand what was being done to her but “at the same time was considered sufficiently 
mature to continue the tradition when she had a daughter of her own”. 

Who Performs FGC on Girls? 

According to Ghadially, khatna is carried out by mullanis, midwives and doctors. Sahiyo’s 
survey supports this claim, as 74% of women reported being cut by a traditional cutter and 
15% reported being cut by a health professional. 

Physical Health Consequences of FGC 

Interviewees from Ghadially’s study reported no serious health or reproductive 
repercussions due to khatna, although a Dawoodi Bohra doctor she interviewed attested to 
seeing cases of girls with “infection, swelling, severe bleeding, shock, tetanus”. Sahiyo’s 
survey found that 23% of the respondents reported undergoing physical health issues 
immediately after FGC, which included pain, bleeding, and burning during urination. (Thirty- 
seven percent could not remember if they faced any physical health issues). 

Interestingly, while only 71 women or 23% reported experiencing physical health 
complications after FGC in the objective component of the question, a larger group of 
women, 128 women, or 98% mentioned experiencing pain in the subjective or narrative 
component of the question. 

Islamic Relief Canada (2013-2016) found that amongst their Indonesian study, there was no 
evidence of major physical complications due to FGC, but, interviewees did depict 
incidences of pain, fever and bleeding. 

Narrative Elements of the FGC Survey 

Ghadially’s (1991) study includes a description of khatna by a cutter within the Dawoodi 
Bohra community. This description contains elements similar to what respondents in 
Sahiyo’s survey recalled of their own FGC experience. Of the 385 survey participants, 309 
women had undergone FGC. Within this group, 131 women provided details on their FGC 
experience. The similar elements included the use of 1) a razor or sharp object, 2) a powder 
mixture to put over the clitoris for healing purposes, and 3) the girl being held down by her 
mother or another woman during the procedure. The following survey participant’s quote 
exemplifies these story elements: 

‘I remember my mum whispering with my granny and aunties that time had 
come now. Then she mentioned to my dad who said do what's needed. She 
told me we were going to buy a doll, took me to a woman's house in a bohra 
community housing set up. We were told to wait in the sitting area, another 
friend of mine was sitting with her mum. She was called in first, I heard 
screaming and then she came out supported by her mum. I was taken in next, 


53 


the lady told my aunt to lay me on a table, remove my undies. My mum had 
left because she said she couldn't watch. My aunt held me down tightly, the 
lady removed a new razor blade in front of me and then bent down between 
my legs. I felt a sharp cut, heard myself scream and cry. The lady then gave 
me cotton wool and my aunt put it in my undies to absorb the blood. We were 
then led out of the room. For a week after, my mum washed my vagina with 
diluted dettol and the matter was hushed up and never talked about.’ (sic) 

The cutter in Ghadially’s study also explained that the girl is told not to speak of what 
happened to her to anyone. This response was given by respondents in Sahiyo’s survey as 
well. 


‘I didn't know anything. My mum told me to come lie on the bed and it was 
performed. Afterwards mum explained a little that every girl has to go through 
this and not to tell anyone, meaning brothers and friends.’ 

The cutter also noted that some girls were told a worm was removed from their stomach. 
This, too, was stated by some respondents in Sahiyo’s survey, as highlighted in this next 
quote: 


‘I hardly remember the happenings around it, all I remember is that I was 
taken there by my mum and my caretaker to this strange, poor and dungy 
home of a (Katchi) woman who was probably a midwife and there I was forced 
to open my legs and was told there was a worm that needed to be removed. I 
remember coming home padded with cotton wool and in a lot of pain. I was 
made to rest and sleep in bed all day! Don't remember anything after.’ (sic) 

Sahiyo’s survey results differ, however, with respect to the physical reaction of the girl 
experiencing khatna. According to the cutter in Ghadially’s 1991 study, there were no 
immediate consequences of khatna: 

There is no bleeding unless the girl is difficult to manage. She [the cutter] 
recommends to the mother that the genital area be washed with warm water 
and antiseptic and the girl be given coconut water to drink to help in the 
discharge of urine. The wound is healed in a day or two. Post circumcision 
complaints are rare. Occasionally mothers come saying that the girl won’t 
permit them to wash the circumcised area (p. 19). 

But in Sahiyo’s survey, of the 131 women who provided details of their FGC experience, 
98% described experiencing pain immediately afterwards. Survey respondents also 
mentioned experiencing bleeding, screaming, being unable to walk, sit on the toilet, pain 
during urination, and blacking out due to the experience. Survey respondents recalled the 
experience as horrible or scary and stated that they felt traumatized, or were angry about 
having to undergo the experience. The following two quotes illustrate the trauma felt by the 
survey participants immediately after they underwent FGC. 


54 



‘Awful experience, painful beyond belief, lifelong emotionally and 
psychologically scarring. I was taken to a tiny apartment, told to take off my 
underwear and cut with a knife that was heated up on a stove. There was 
ample blood and excruciating pain.’ (sic) 

‘It was the most horrific experience of my childhood and something that I will 
remember for the rest of my life. I was taken to some random shack in some 
random village and a lady that I had never met in my life held me down and 
took a knife to me. I just remember screaming and crying through the entire 
thing and being in pain for the next week or so. I would absolutely never have 
my child ever go through such an experience in her life.’ 

The difference in opinion between the cutter and the reported experiences by Sahiyo’s 
survey respondents clearly indicates a disconnect in the understanding of the various 
physical and emotional reactions faced by a girl who undergoes FGC. 

Emotional Impact on Adult Life 

None of the earlier Dawoodi Bohra case studies discussed the emotional impact of 
undergoing FGC in the woman’s adult life. Sahiyo’s study found that about half - 48% of the 
309 participants who had undergone FGC - stated that their FGC had left an emotional 
impact (Question #25). Survey participants were given the opportunity to provide more 
details in narrative form regarding the emotional impact FGC had on them as demonstrated 
by the response below. 

‘As the years rolled by, I attained puberty, and after experiencing my first 
menstruation, I became aware of my sexuality. At this point of time, my 
second eldest sister, in order to give me an understanding of sexual 
knowledge, gave me a book to read - 'Encyclopedia of Sexual Knowledge' 
authored by Dr. Van de Velde. After reading that book, the full impact and 
realization of that awful, painful and life-changing procedure which I was 
made to undergo at the innocent age of seven years, dawned on me. I was 
privately distraught and enraged to learn that I had been robbed of my basic 
feminine rights to sensuality and sexuality, and forever, deprived of any 
clitoral sexual stimulation. This feeling disturbs and traumatizes me even 
today. I feel robbed and cheated of my sexuality, and feelings of inadequacy 
and incompleteness remain with me till today, even at the age of 61. The 
emotions of impotent rage and anger refuse to leave my mind or my spirit. 
After making a private self-examination, I found that the prepuce or the entire 
foreskin of my clitoris had been cut off.’ 

Of the 309 respondents, 35% of the women stated that the FGC had impacted their sex life 
as adults, the majority implying that their sex life had been affected negatively (Question 


55 


28). However, as mentioned earlier, 65% of survey participants were unsure of what had 
physically occurred to them. Thus Sahiyo’s study was unable to conclude if FGC had 
caused their sex life to be unfulfilling. Survey participants’ narrative responses reflected 
both 1) the negative impact on their sex life, and 2) the uncertainty of whether or not their 
sex life had been impacted by FGC. The following quotes demonstrate these varied 
experiences: 

‘I am unable to reach a clitoral orgasm. If much stimulation of my clitoris is 
attempted, I experience soreness and a burning sensation. I also very rarely 
experience vaginal orgasm because of lack of sufficient arousal and 
stimulation of my genitalia particularly the clitoris.’ 

‘Given that my circumcision was done more for symbolic reasons to merely 
satisfy the religious decree, the procedure didn’t have any adverse physical 
implications (thankfully) in my life. Having said this, since I was obviously 
not sexually active at the age of 6-7 years, I am unaware if the procedure has 
positively or negatively affected my sexual life!’ 

‘I was not comfortable in allowing penetrative sex. I felt anxious, nervous and 
would start to shiver, until my husband would give up seeing my strange 
behaviour. I would normalise immediate after he would withdraw. He would 
be normal but I would suffer the guilt pangs.’ 

‘The khatna has not left any obvious physical evidence. No gynecologist or 
other medical doctor has ever remarked or even noticed that my genitalia 
looked at all different. There have been issues with my inability to properly 
enjoy sexual intercourse, however I don’t believe that these are linked to the 
khatna. Rather medical professionals have said these are due to other factors. 
Frankly, as confused and angry as I was as a young girl, and as much as I 
think this abhorrent and unnecessary practice should end, I don’t believe that 
it had a lasting physical impact on my sexual health.’ 

Despite the varied experiences relating to the emotional and sexual life of survey 
participants, the overall negative reactions of the women points to the need for support 
services for survivors who have faced emotional trauma/psychological trauma due to FGC - 
more so, perhaps, than the need for physical health-related support services. 

Men’s Knowledge of FGC 

Ghadially (1991) claimed that a girl’s FGC was kept an absolute secret not only from 
outsiders, but also from men in the Dawoodi Bohra community. Yet, when respondents from 
Sahiyo’s survey were asked if men were aware of FGC in the community, an overwhelming 
majority reported “yes” (72%). Considering Ghadially’s case study was conducted in 1991, 
and with the advent of the internet, social media, and the fact that the media in India has 


56 


highlighted the issue of FGC within the last two years, Sahiyo’s findings might reveal that 
the topic of FGC is no longer considered a guarded secret amongst men from the 
community, or even for that matter, the general public. However, when asked if men were 
aware of when a female relative underwent FGC, 39% were unsure and 34% believed that 
men were not told about it. 

Reasons for Continuing FGC 

Muteshi (2016) stated that “FGM/C is a sensitive practice that is embedded within complex 
socio-cultural systems. Reasons vary across countries and cultures”. She goes on to 
explain that one community might provide several reasons or even contradictory reasons for 
the continuation of the practice, a statement that is corroborated by the earlier Dawoodi 
Bohra case studies and Sahiyo’s study within the Dawoodi Bohra community. 

In April 1991, Srinivasan stated that FGC was not explicitly required by the Dawoodi Bohra 
religion, but that families continued the tradition out of fear that they would incur the 
disapproval of religious leaders if they abandoned it. In contrast, Ghadially (1991) indicated 
that khatna was endorsed by the clergy, who often provided permission and support to 
traditional cutters (who are Dawoodi Bohra women mostly from low-income families). 
Taher’s study also found that the clergy recommended FGC be continued (2010). 
Additionally, participants in Taher’s study reported that though their mothers were 
responsible for making the decision to have them cut, this decision was heavily influenced 
by religious leaders (2010). These findings suggest that because the practice is linked to 
religion, it may be more strongly connected to the need for culture-based social inclusion. 
The following survey participant quote from Sahiyo’s study highlights the idea that FGC for 
the Dawoodi Bohras is in fact a must for social inclusion into the community, as the survey 
participant noted that other Muslims don’t perform the practice. 

‘I vividly remember this painful procedure. Before we realized my cousin and 
me were taken to a old maasi [elder woman]. The event was painful and I 
cried with pain and even questioned my mother about this. She had no answer 
except just told me that it was religiously required. I bled for a couple of days, 
it scared me so much that i was afraid of passing urine. Even enquired from 
my other Muslim friends whether they had undergone this khatna, to which 
they nodded in refusal.’ (sic) 

Yet, religion emerges as only one of the reasons for the continuation of FGC. In Ghadially’s 
study, the most commonly cited reasons for practicing khatna were that it is a religious 
obligation, a tradition, and that it curbs a girl’s sexuality (1991). These findings are 
consistent with Sahiyo’s survey results, in which respondents cited multiple reasons for 
performing FGC, including for religious purposes (56%), to decrease sexual arousal (45%) 
and to maintain traditions and customs (42%). Ghadially reported that a less commonly 
cited reason for FGC was cleanliness, a finding that fell in line with Sahiyo’s study results: 
only 27% of the participants listed physical hygiene and cleanliness as a reason for FGC. 
Taher’s study also reported several different reasons for FGC within the Dawoodi Bohra 
community, including hygiene and cleanliness, religion, sexual control, and tradition (2010). 


57 


All three studies suggest that the continuation of FGC is deeply rooted in the community’s 
culture. 

The Dawoodi Bohra community can also be viewed as an ethnic community within South 
Asia. FGC can therefore be seen as a practice that helps solidify the community’s identity. 
Shell-Duncan et al. (2016) have stated that FGC is a practice that is “more strongly 
associated with ethnicity than any other personal characteristic”. Ethnicity, they explain, 
serves as a proxy for shared norms or values concerning family honor, factors related to 
marriageability, sexual restraint, coming of age, or other codes of conduct. Given that FGC 
is a marker of these norms, the practice can become highly valued by some members of the 
community and thus strongly protected. Several survey participants remarked on the 
reinforcement of the practice of FGC by their family members in the narrative section 
regarding their khatna experience (Question 22). The following quote is one such example. 

‘I don’t recommend doing it to our children however, I had done it to my 
daughter due to pressure from my mom but did it at the hospital by a doctor. I 
regret it though’ (sic) 

This reasoning helps to explain the ideology behind why FGC is performed for sexual 
control. While Sahiyo’s study did not delve into asking why sexual control of women was 
necessary within the community, Taher’s study suggested that the purpose behind 
controlling a woman’s sexuality was religion: 

‘Those women who mentioned FGC was done to decrease a woman’s 
sexuality stated that within Islam, women were not supposed to be sexually 
aggressive and by removing a piece of the clitoris’ foreskin, a woman’s 
aggressiveness towards sex is curbed. Yet, within the Dawoodi Bohra strain, 
one participant explained that the actual procedure of removing a piece of the 
foreskin, no bigger than your pinky fingernail, exposes a woman’s clitoris 
more and that the religious teachings or taweel behind this practice claims 
that by having both the male and female circumcised, a certain kind of 
knowledge or ilm is passed between those engaged in the act of sex, and this 
ilm makes the sex more pleasurable’ (2010, p. 37). 

Ghadially (1991) further clarified that the need to curb female sexuality was closely related 
to the fact that women safeguarded the izzat (honor) of the family. She stated: 

‘Indian Muslim society, like many other traditional societies, uses double 
standards for judging men and women and demands from women complete 
adherence to these double standards. Any deviance from the codes of morality 
prescribed for women threaten the izzat of her kin group. Unlike other Muslim 
women in India, the sexual desire of Bohra women is curbed both physically 
and culturally. The task, as expected, is accomplished by enforcement from 
older women of the family’ (p. 18). 

Srinivasan (1991) also claimed that FGC was done amongst the Dawoodi Bohras to control 
the sexuality of women, and that family structure played a part in continuing FGC from 

58 



generation to generation. She suggested that FGC was a status symbol among wealthy, 
orthodox families and that because Dawoodi Bohras typically lived with their extended 
family, the elder women in the family ensured their family’s honor was continued through 
strict adherence to customs. Although Sahiyo’s survey did not include questions relating to 
family structure, a lack of adherence to customs and tradition has commonly been cited by 
Dawoodi Bohra community members as reasons for excommunication from the community 
(Johari, 2015). This fear of social ostracism indicates that for the Dawoodi Bohras, not 
participating in the continuation of FGC might lead to stigmatization from the society 
because women who had not undergone FGC would not be the norm. Thus, families who 
abandon FGC can face high social costs, including exclusion from social support, events, 
and opportunities (Shell-Duncan, 2016). 

Educational Level of those who Undergo FGC 

Shell-Duncan et al., (2016) indicated that there was a strong link between women’s 
education and the continuation of FGC. Eighty percent of Sahiyo’s survey respondents had 
earned at least a Bachelor’s degree. Yet, data analysis did not reveal a relationship 
between education level and having undergone FGC. 

Shell-Duncan et al., (2016) also suggested that the connection between a mother’s 
education level and her tendency to continue FGC on her daughter could be that more 
educated women participated less in social networks where female relatives are able to 
exert a strong influence on whether a child should undergo FGC. 

Yet, considering the high education level of Sahiyo survey participants, and that there was 
no statistical difference in the amount of socialization within the Dawoodi Bohra community 
and whether or not a person had undergone FGC, “socialization” within the community may 
not be an important factor in determining whether or not a girl is at risk of FGC. The 
question of a person’s ideological preference (stated religion) however, might provide clues 
as to whether this influences a person’s decision to continue FGC on their daughter. In fact, 
Sahiyo’s survey found that those who were most likely to continue ‘khatna’ were also more 
likely to still identify as Dawoodi Bohra in their adult life. 

Continuation of FGC 

Shell-Duncan et al., (2016) reported that both men and women believed the practice should 
end. Results from Sahiyo’s study also suggested that men and women want the practice to 
end in the Dawoodi Bohra community. 

According to Taher’s study of six participants, 83% of participants indicated FGC to be a 
widespread practice in the Dawoodi Bohra community living in the United States (2010). 
Sahiyo’s survey also indicated FGC to be a widespread practice among the global Dawoodi 
Bohra community, the majority of respondents believing FGC to be prevalent at a rate of 
61% to 100% in the Dawoodi Bohra community. These high figures indicate FGC to be a 
social norm within this community. 


59 


However, looking at trends of continuation of FGC onto the next generation, Sahiyo’s 
survey results differed from Ghadially’s case study. More than 70% of the Dawoodi Bohra 
women Ghadially interviewed had continued khatna on their daughters without questioning 
it (1991). Sahiyo’s survey suggested that 82% of survey participants would not continue 
FGC on their daughter. Taher’s study (2010) also found the number of women who would 
continue FGC on their daughters to be small - only 33%. 

These results suggest that though FGC is considered a widespread practice in the Dawoodi 
Bohra community, trends towards abandonment of the practice have perhaps begun. 

Shell-Duncan et al., (2016) proposed that one way to track the rate of abandonment over 
generations included comparing the difference between the youngest and oldest age 
groups, as it could give a clearer indication of any changes that have occurred recently 
among the younger cohorts. 

Yet, when Sahiyo analyzed data to see if survey participants’ attitudes towards abandoning 
FGC changed with participant age group, it was revealed that older women, aged 46 and 
above, were more likely to want FGC to discontinue (93%) compared to women 25 years 
and younger (70%). A possible reason for this contradictory conclusion could be that older 
women, who have more privacy/agency in traditional family structures, hold more of an 
influence over the decision to continue FGC on a child. 


60 



Conclusion 


61 


Conclusion 


Implications for Ending FGC 

It is imperative to have a clear understanding of the scale and scope of the practice of FGC 
around the globe so that policymakers, donors, program developers, health professionals, 
and other key stakeholders know how to contribute to ending this form of gender violence. 
Muteshi (2016) stated that a challenge to ending FGC is that there has been a lack of 
adaptation to the local context. The purpose of this report was to understand the 
perceptions, beliefs and rationales of the practice among Dawoodi Bohras globally in order 
to create policies and programs that aid in the abandonment of FGC amongst South Asian 
populations. 

Shell-Duncan et al., (2016) indicated that FGC is a practice that is intricately woven into the 
fabric of social networks and tied to important cultural norms and values. Sahiyo’s study 
demonstrates that regardless of the justification given for the continuation of this practice, 
FGC is deeply rooted in the Dawoodi Bohra community’s culture. Therefore, understanding 
the complex social norms and cultural value systems that shape the practice’s meaning and 
significance within this community is critical to the work of anti-FGC advocates. For 
instance, understanding the age at which girls typically undergo FGC in this community can 
help child protection professionals identify when a girl might be a risk. Or, recognizing that a 
large percentage of Dawoodi Bohra survey participants lacked basic understanding of the 
female anatomy, and thus the subsequent physical harm incurred by FGC, could point to a 
vital need for more sexual health education in schools to counter any beneficial perceptions 
of FGC that Dawoodi Bohras misguidedly believe in. 

Similarly, Sahiyo’s study demonstrates that the justification given for FGC can vary over 
time. Anti-FGC advocates should acknowledge this fluidity and lack of uniformity in 
rationales for why FGC occurs as an opportunity to understand which community-based 
strategies would be most effective for facilitating the abandonment of the practice. 

For instance, in 2016, as the topic of khatna within the Dawoodi Bohra community gained 
media attention, for the first time, religious authorities provided public statements regarding 
the continuation of the practice. The head of the religious community, Syedna Mufaddal 
Saifuddin, made a public speech in April 2016 stating that “the act” must continue, 
'discreetly for girls', implying that Dawoodi Bohras must secretly practice it even in countries 
where it may be illegal (Das, 2016). 

However, in an official press statement in June 2016, the religious authorities clarified that 
FGC must be performed in countries such as India where the practice has not been made 
illegal, and must not be performed by diaspora Dawoodi Bohra communities who live in 
countries where it is illegal (Chari, 2016). Meanwhile, a separate faction of the Bohras, 
under the leadership of Syedna Taher Fakhruddin, condemned FGM, calling it “an un- 
Islamic and horrific practice”. Yet, this religious leader also maintained that ‘khatna’, as 
mentioned in the Dawoodi Bohra religious book Daim al-lslam, is different from FGM and 
should be done ‘electively’ after a girl reaches adulthood. Fakhruddin stated that khatna is 


62 


akin to the clitoral unhooding procedure which is medically and legally sanctioned in many 
countries and is done to enhance the sexual pleasure of women, not to suppress it (Ashar, 
2016). This variance in justification for why FGC should continue has allowed for public 
dialogue within the community, which advocates have been able to use to nurture public 
debate. 

Keeping abreast of systematic changes within the community’s culture is important for anti- 
FGC advocates who are looking for windows of opportunity in which the abandonment of 
this harmful practice can be encouraged. 

Future Research 

The snowball sampling technique used for this study was deemed most appropriate, since 
those who have undergone FGC within the Dawoodi Bohra community are considered to be 
a hidden population and thus difficult to access. By utilizing an online system of gathering 
data, the researchers were able to cater to the global nature of the Dawoodi Bohra 
community as well. As show in Question 2, 80% of respondents stated they had earned at 
least a bachelor's degree, which falls in line with findings given by Jonah Blank (2001) in 
Mullahs on the Mainframe, and with anecdotal evidence collected by Sahiyo that the 
community is highly educated and prides itself on the use of technology to convey 
information to Dawoodi Bohra religious congregations globally. 

Yet, biases do exist in this survey. It is possible that due to the secretive nature of the topic, 
women who may be in favor of continuing FGC may have chosen not to participate in the 
survey, increasing the likelihood that survey participants would only include those women 
who have chosen to discontinue the practice. Future research should include looking at 
methods of collecting quantitative data in a systematic manner in which participants are 
randomly chosen from a sampling frame. 

Findings from this report also indicate that future studies should include surveying various 
other stakeholder groups connected to FGC, such as social service providers, religious 
leaders and men within the community. Healthcare professionals (pediatricians, 
gynecologists, nurses) should also be interviewed as they may come into contact with FGC 
survivors in their professional capacity, and their experiences can build knowledge on the 
physical effects of the least severe forms of FGC practiced globally. 

After reviewing the literature, it is clear that there is a dearth of knowledge about the 
physical, psychological, and sexual ramifications of Type I FGC as it is performed amongst 
the Dawoodi Bohras. In fact, both Sahiyo’s study and the Islamic Relief Canada (2013- 
2016) study indicated that there was a lack of awareness regarding the female anatomy 
amongst survivors who underwent the practice, thus making it challenging for survivors 
themselves to indicate if they were having physical challenges relating to their FGC. 
Ghadially (1991) also pointed out this drastic lack of literature on Type I FGC: most 
literature on FGC is concentrated on the more severe types, including clitoridectomy and 
infibulation, practiced in Africa, while there is an apparent lack of literature on the ‘sunnah’ 
version of FGC noted to occur in many Asian countries. 


63 


Data collected from Question 31 in the survey indicated that contrary to anecdotal evidence 
collected by Sahiyo, most of the survey participants believe that men were aware of the 
practice of FGC. Considering FGC is often thought to be a symbol of patriarchal oppression 
of women, future research should include surveys of men to see if they are actually aware 
of FGC occurring amongst their female relatives. According to Shell-Duncan et al. (2016), 
existing data demonstrates that the majority of men in many countries do not support the 
continuation of FGC. If future research shows that Dawoodi Bohra men do not support 
FGC, men could become an important ally in ending FGC within this community. 

Other future research should include comparative studies between the practice of FGC 
within India and amongst diaspora communities, investigations into the effect of outlawing 
FGC within countries where diaspora communities reside, and the significance of the 
practice for those choosing to continue it in spite of criminalization. 


64 



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complications from female genital mutilation. Retrieved from 
http://apps.who.int/iris/bitstream/10665/206438/1/WHQ RHR 16.03 enq.pdf?ua=1 

World Health Organization. (2016). Classifications of female genital mutilation. 

Retrieved from http://www.who.int/reproductivehealth/topics/fqm/overview/en/ 

World Health Organization. (2010). Global Strategy to Stop Health-care Providers from 

Performing Female Genital Mutilation UNAIDS, UNDP, UNFPA, UNHCR, UNICEF, 
UNIFEM, WHO, FIGO, ICN, IOM, MWIA, WCPT, WMA. Switzerland. Retrieved from 
http://whqlibdoc.who.int/hq/201 0/WHO_RHR_1 0.9_eng.pdf 
World Health Organization. (2001). Female Genital Mutilation: Integrating the 

Prevention and the Management of the Health Complications into the Curricula of 
Nursing and Midwifery: A Teacher's Guide. Retrieved from 
http://www.who.int/gender/other_health/teachersguide.pdf 


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Glossary 


69 


Glossary 

Alavi / Aliya Bohras (popularly called Aliya Vohras, or just Aliyas) - A small Bohra sub- 
sect that broke away from the larger Bohra sect in the early 1600s. The other two major 
sub-sects formed around that time were the Dawoodi Bohra and the Suleimani Bohra. Each 
sect has its own Da’i or religious leader. The Alavis are largely a trading community with 
their headquarters in Vadodara, in the Indian state of Gujarat. Their population is roughly 
10 , 000 . 

Bhai-Sahab - Title given to general male members of the religious clergy. 

Bohra/Bohras - see ‘Dawoodi Bohra’ 

Da’i al-Mutlaq (Da’i), Syedna or Maula - The title used for the religious head of the clergy 
of the Dawoodi Bohra community. The Da’i is the Imam’s vicegerent, with full authority to 
govern the Dawoodi Bohra community in all matters both spiritual and temporal. 

Daim al-lslam (The Pillars of Islam) - A book of Islamic jurisprudence followed by many 
Musta'li Ismaili Shias, including the Bohras. It was written in 960 AD by Qazi al-Numan, the 
official historian for Fatimid caliphs. The book is divided into two volumes. Volume I deals 
with matters of faith, devotion, ritual purity, prayer, funerals, fasting, pilgrimage, and jihad. 
Volume II deals with a wide range of subjects such as food, dress, medicine, oaths, 
marriage, divorce, inheritance, criminal punishments and the etiquette of judges. 

Dawoodi Bohra - The ‘Bohras’ are a Shia Muslim sub-sect of the Tayyabi Mustali branch 
of the Ismailis, who trace their religious and literary heritage to the Fatimid caliph-imams of 
North Africa, Egypt and Yemen in the 10th and 11th centuries. In the latter half of the 11th 
century, Fatimid missionaries also converted numerous indigenous Hindus on India’s 
western coast to this sect of Islam. Bohras believe in the Da’i al-Mutlaq as their religious 
and spiritual leader. 

In the 1500s, facing persecution in Yemen, the seat of the Da’i shifted to Gujarat on India’s 
western coast, where the Bohras eventually flourished as a trading community. In the 
1600s, the Bohra sect split into three sub-sects - Dawoodi, Alavi and Suleimani. Of these, 
the Dawoodi Bohras are the largest sub-sect, with an estimated population of 1.5 to 2 
million around the world, of which around half are in India. Dawoodi Bohras have their own 
distinctive language, dress, food and culture and have developed a reputation for being 
well-educated and wealthy. 

For the purposes of this report, ‘Bohra/s’ refers to the majority Dawoodi sub-sect. 

“Fatimid” tradition -Dawoodi Bohras trace their spiritual heritage from Prophet 
Mohammed and his son-in-law, Moula AN, and continuing through their successors, the 
Imams who, functioning first from Medina, spread over to North Africa and Egypt in the 
succeeding centuries. Imam Al-Mehdi Billah set out for North Africa and established his 
religious kingdom in Tunisia and the adjacent territories. Three Imams succeeded him and 
the fourth, Imam Al-Moiz Le-Dinillah, established his seat of authority in Egypt. The 
kingdoms these Imams founded, the traditions of thought and philosophy they fostered, the 
immense literature they produced and guarded, the civilization they established and the way 

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of life they pursued have all come to be called Fatimi or Fatimid after Fatima, the daughter 
of Prophet Mohammed and the consort of Imam AN, thus linking two venerable personalities 
together. 

Hadith -Tradition based on the precedent of Muhammad's words that serves as one of the 
sources of Islamic Law (Shariat). 

Imam - Shia Muslims believe that Imams, who are the religious leaders of the community, 
are chosen by God to be the perfect examples for the faithful and to lead all humanity in all 
aspects of life. Within the Dawoodi Bohra tradition, the Imam has gone into seclusion, 
therefore the Da’i serves as the supreme religious head of the community. 

Ilm -Urdu word for knowledge 

Izzat- honor, reputation, prestige 

Jamaat -Arabic word for gathering or congregation. In the Bohra context, it also specifically 
refers to a collective of all Bohras within a specific geographic location, akin to a parish. 

Khafd / khafz - The specific Arabic term for female circumcision in the Dawoodi Bohra 
community. 

Khatna - the term used for circumcision among Dawoodi Bohras. Although the term is 
common for both male and female circumcision, in this report it is used specifically to refer 
to female circumcision. 

Lisan al-Dawat- the official language of the Dawoodi Bohra community, written in the 
Arabic script but derived from Urdu, Gujarati and Arabic. 

Mullani - a Bohra woman with semi-religious standing, according to R. Ghadially, ‘All for 
Izzat’, Manushi, 1991. 

Sabaq / Sabak - sermons in religious education held at Dawoodi Bohra mosques. 

Suleimani Bohra - One of the three sub-sects of Bohras that split from the Bohra 
mainstream in the early 1600s. The community has its headquarters in Mumbai although its 
population of more than a million is spread out around the world. 

Sunnat / Sunnah - In general, the word Sunnah means habit, practice, customary 
procedure, or action, norm and usage sanctioned by tradition. Specifically, it refers to 
Prophet Mohammed’s sayings, practices, and living habits. The Sunnah may confirm or 
interpret something that is revealed in the Qur’an. 

Syedna - see ‘Da’i al-Mutlaq’ 

Taweel- Interpretation. The hidden meaning of a practice or scripture, usually very esoteric 
and requires special permission (raza) to obtain. 


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Appendices 


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Appendix A: FGC Online Survey 

Khatna Survey 


The purpose of this survey is to understand the extent, purpose and impact of khatna** 
amongst Dawoodi Bohra women. 

The sole intention of this research is to shed light on misunderstandings and lack of 
information surrounding this age-old practice, which is not often talked about in social 
circles. It is not the intention of the researcher(s) to discredit or malign any particular 
community, especially the Dawoodi Bohras. However, due to the exclusivity of this practice 
amongst the members of this group of Shi'a Muslims in India, and elsewhere around the 
world where they live or have migrated, the present survey is focusing primarily on them. 

This is a COMPLETELY ANONYMOUS survey. No identifying information will be asked of 
the respondents. In other words, NO names, e-mail addresses etc. are required for the 
purposes of completing this survey. 

Please be truthful in answering the questions, as your response will be representative of the 
larger Dawoodi Bohra women population. Read the questions carefully and answer 
accordingly, as the survey is a ONE-TIME ONLY document. 

For now, we are asking only women 18+ years old, who associate themselves with the 
DAWOODI BOHRA community or who grew up with the DAWOODI BOHRA traditions and 
practices to take the survey. 

**For consistency purposes, khatna refers to the practice of girl child / female genital 
circumcision (removal of the hood, the tissue covering the head of the clitoris, with or 
without partial or total removal of the clitoris) throughout the survey. 

If you are interested in receiving the results of the survey or have other information you 
would like to share, please send an email to khatnasurvev201 5@qmail.com 

Participant Consent 

The researcher(s) requests your consent for participation in a study about understanding 
the extent, purpose and impact of khatna among Dawoodi Bohra women. 

This consent form asks you to allow the researcher(s) to use the data from your online 
survey to enhance understanding of the subject. 

Participation in this online study is completely voluntary. If you decide not to participate 
there will be no negative consequences. 


73 


The researcher(s) will maintain the confidentiality of all the data collected through this 
survey. 

By submitting this form you are indicating that you have read the description of the study 
and that you agree to the terms as described above. You also confirm that you belong to or 
grew up in the DAWOODI BOHRA community, are over the age of 18 and of sound mind 
and health. 

If you have any questions, please contact us at khatnasurvey2015@gmail.com 
Thank you in advance for your participation! 

I agree to participate in the online survey, being a DAWOODI BOHRA women over the age 
of 18 years and of sound mind and health. I understand the purpose and nature of this 
study and I am participating voluntarily. 

• Yes 
. No 

I grant permission for the data generated from this online survey to be used in the 
researchers' publication(s) on this topic. 

. Yes 
. No 

Section 1 : General Information 


1) How old are you? 

. 18-25 

. 26-35 

. 36-45 

. 46-55 

. 56-65 

• 66 + 


2) Education Level: 

Mark one answer - if your country has less grades/standards than 12, please still indicate if 
you completed "Some grades/standards in my country" or "All grades/standards in my 
country" 

• None 

• Some Primary and middle school (KG-7) 

• Completed Primary and middle school (KG-7) 

• Some Secondary school (8-1 2) 

• Completed Secondary school (8-12) 

• Some Graduate degree (B.Sc., B.A, etc.) 

• Completed Graduate degree (B.Sc., B.A, etc.) 

• Some Post-graduate degree (MD, JD, Masters or Ph.D.) 

• Completed Post-graduate degree (MD, JD, Masters or Ph.D.) 

• Other 


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3) Please describe your individual/marital/civil status. 

• Single 

• Married 

• Divorced 

• Separated 

• Common Law 

• Widow 

• Other 

4) What income group* do you currently belong to or identify with? 

• Low income 

• Lower-middle income 

• Middle income 

• Upper-middle income 

• High income 

5) What income group did you belong to or identify with while growing up 

• Low income 

• Lower-middle income 

• Middle income 

• Upper-middle income 

• High income 

6) What religion did you grow up with? 

• Non-practicing 

• Sunni Muslim 

• Dawoodi Bohra 

• Other Shi'a Sect 

• Other 

7) What religion do you most identify with now? 

• Non-practicing 

• Sunni Muslim 

• Dawoodi Bohra 

• Other Shi'a Sect 

• Other 

8) Please describe your profession 

• Homemaker/Housewife 

• Homemaker/Housewife + business from home 

• Teacher 

• Health Field (Doctor, Nurse, etc.) 

• Business woman (outside of home) 

• Legal Field (lawyer, law clerk, judge) 

• Student 

• Engineer 



• Administrative 

• Other 

9) Where do you currently reside? 

• India 

• United States 

• Australia 

• United Kingdom 

• Pakistan 

• United Arab Emirates 

• Tanzania 

• Kenya 

• Uganda 

• Egypt 

• Canada 

• Bangladesh 

• Sri Lanka (previously Ceylon) 

• Other 

10) Do you socialise/interact with other Dawoodi Bohras on a regular basis? 

• Regularly (A couple of times per week) 

• Sometimes (Every couple of weeks) 

• Hardly (Every couple of months) 

• Almost never (Once or twice a year) 

• Not at all 

11) Are you aware of the prevalence of khatna / female genital circumcision in the 
Dawoodi Bohra community? 

• Yes 
. No 

12) Do you have friends or family members on whom khatna was performed? 

Mark all those options that apply 

• Yes - Family Member 

• Yes - Friends 
. No 

13) Was khatna performed on your mother? 

Please check all that apply 
. Yes 
. No 

• I don't know 

14) Was khatna performed on you? 

• Yes 
. No 

-Section 2~ 


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Personal Experience - Please go to Section 3 if your answer to the previous question 
regarding if you had undergone khatna was "No". 

15) How old were you when the khatna was performed on you? 

Please skip if the answer to your previous question was "No" 

• 0 to 5 

• 6 to 7 

• 8 to 9 

. 10 to 11 

. 12 + 

• I don't know 

16) Who made the decision that the khatna should be performed on you? 

Please check/tick mark all that apply. 

• Mother 

• Other female family member(s) 

• Father 

• Other male family members(s) 

• Mother and father 

• I made the decision myself 

• Religious leaders 

• Wives of religious leaders 

• I don't know 

• Other 

17) In which country was khatna performed on you? 

• India 

• United States 

• Australia 

• United Kingdom 

• Pakistan 

• United Arab Emirates 

• Tanzania 

• Kenya 

• Uganda 

• Egypt 

• Canada 

• Bangladesh 

• Sri Lanka (previously Ceylon) 

• Other 

18) Were you taken out of the country that you reside in to have khatna performed on 
you? 

• Yes 
. No 

• I don't know 


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19) In what location was the khatna done? 

• Hospital/Health Clinic 

• Private residence (home) 

• Other 

20) By whom was the khatna performed? 

• Gynecologist 

• General Practitioner/Family Doctor 

• Traditional Cutter/midwife 

• Nurse 

• Other 

21) What type of "cutting" or physical modification was performed when you 
underwent khatna? 

• Part of the clitoral hood removed 

• All of the clitoral hood removed 

• Clitoral hood and part of clitoris removed 

• Clitoral hood and all of clitoris removed 

• I don't know 

• Other 

22) If you remember, please describe the details surrounding your khatna. 

23) Did you face any physical or health issues immediately after khatna? 

For example: excess bleeding requiring a visit to the doctor, discomfort/burning sensation 
while urinating, wound infection, etc. 

• Yes - Please describe what physical or health issues you have faced in the "Other" 
field. 

. No 

• I don't remember 

• Other 

24) What was your emotional or mental state immediately after the khatna was 
performed? 

Please check/tick mark all that apply. 

• Flappy 

• Ambivalent 

• Sad 

• Scared 

• Angry 

• Don't remember what I was feeling 

• Other 

25) Has the khatna procedure left any emotional impact on you in your adult life? 

If your answer is "Yes", please describe in a few words under the "Other" field how khatna 
has left an emotional impact on you in your adult life. 

• Yes 
. No 


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Other 


26) Has khatna affected your sexual life? 

If you answer is "No", you can skip the next question and proceed to Section 3. 

• Yes 
. No 

• I don’t know 

• I am not sexually active 

• Other 

27) If khatna has affected your sexual life (answer to question 26, above), is it 
positively or adversely? 

If you desire, please feel free to elaborate under the "Other" field how khatna positively or 
adversely affected you. 

• Positively 

• Adversely 

• Other 

28) If you wish to elaborate on the effects of khatna on your sexual life, please 
describe below. 

For example: heightened physical stimulation, increase in sexual desire, lack of physical 
stimulation, inability to orgasm, discomfort while engaging in sexual activity, etc. 

-Section 3- 
Social Experience 

29) What would your Dawoodi Bohra relatives and friends think if they knew a 
Dawoodi Bohra woman had not undergone khatna? 

Please check/tick mark all that apply. If you select "Other", please elaborate. 

• They would think nothing of it 

• They would be very surprised 

• They would be upset 

• They would not want that woman to marry their son 

• They would think that the woman was unclean 

• They would think that the woman is not a "true" Dawoodi Bohra 

• We don't discuss khatna 

• I don't know 

• Other 

30) What explanations have your heard as to why khatna is practised by the Dawoodi 
Bohras? 

Please check/tick mark all that apply. If you select "Other", please elaborate on the 
explanation(s). 

• For religious purposes 

• For reasons of physical hygiene and cleanliness 

• To maintain traditions and customs 

• To decrease sexual arousal 


79 



• To increase sexual arousal 

• To gain respect from the community 

• As a necessary requirement for a good marriage 

• Other 

31) Do you believe men (fathers, brothers, uncles, etc.) are aware of the practice of 
khatna? 

• Yes 
. No 

• I don’t know 

32) Do you think that your male relatives expect all Dawoodi Bohra women to do 
khatna?" 

• Yes 
. No 

• I don’t know 

33) Do you think men are told of the practice of khatna when their female relatives 
undergo it? 

. Yes 
. No 

• I don’t know 

34) If you had/have a daughter/grand-daughter would you continue the tradition of 
khatna with them? Please grade on a scale of 'Extremely unlikely' to carry on the 
tradition of khatna with them to 'Most likely' to carry on the tradition of khatna with 
them. 

• 1=Extremely unlikely 

• 2=Unlikely 

• 3=Undecided 

• 4=Likely 

• 5=Most likely 

35) How do you feel about the practice of khatna continuing forward? Please grade 
on a scale of 'I am not OK' with khatna continuing forward to 'I am OK' with khatna 
continuing forward. 

• 1=1 am not OK 

• 2=1 am slightly not OK 

• 3=1 am unsure 

• 4=1 am slightly OK 

• 5=1 am OK 

36) In your opinion, how prevalent do you believe khatna is in the Dawoodi Bohra 
community? 

Please estimate the percentage of females who have undergone FGC in the entire 
community? 

. 0-20% 


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. 21-40% 

. 41-60% 

. 61-80% 

. 81-100% 

37) Do you know if khatna is being performed amongst other communities than the 
Dawoodi Bohras in India? 

If your answer is "Yes", please mention the community names under "Other". 

• Yes - Please mention the names of the communities under "Other". 

. No 

• Other 


81 



Appendix A: FGC Online Survey 

Draft script to use: 

Dear XYX, 

I was given your contact by <friend/family etc.>. 

As I am from the Dawoodi Bohra community, I am writing on behalf of my friend/colleague 
who is pursuing graduate research to understand the extent, purpose and impact of the 
practice of khatna amongst the Dawoodi Bohras. 

I understand that this is a very personal and sensitive subject matter that almost no one 
talks about, and this makes knowledge gathering on this practice even more important. The 
information you will be providing the researcher will go a long way throwing light on this 
age-old practice of khatna amongst the Bohra community. It is completely anonymous and 
you will not be asked for any personal identification in order to complete it. I would also like 
to reassure you that the purpose of this research is not to malign or discredit any particular 
community, especially the Dawoodi Bohras. 

I humbly request you to take some time out of your busy schedule to fill out this survey - 1 
don't think it will take more than 5-1 0 minutes of your time. 

If you have questions, you can reach me at my email or write to the researcher at 
info@sahivo.com . 

Thanks for your help! 


82